The hypothalamic-pituitary-adrenal axis in critical illness: response to dexamethasone and corticotropin-releasing hormone.
The hypothalamic-pituitary-adrenal axis in critical illness: response to dexamethasone and corticotropin-releasing hormone.
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危重病中的下丘脑-垂体-肾上腺轴：对地塞米松和促肾上腺皮质激素释放激素的反应。
DOI：
10.1210/jcem.77.1.8392081
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Winkelmann
中科院分区：
文献类型：
--
作者：
Martin;Reincke;Bruno;Allolio;Guido;Wurth;Werner;Winkelmann
重症监护病房(ICU)患者的血浆ACTH和皮质醇浓度经常升高。为了检查危重疾病期间下丘脑-垂体-肾上腺轴的功能完整性，我们对53名住在普通内科ICU的ICU患者进行了前瞻性评估。31例患者和7名正常对照组进行了过夜地塞米松抑制试验(2300h口服地塞米松3 mg)。在一项单独的实验中，22名患者和7名对照受试者接受CRH刺激试验[100微克人(H)CRH，静脉注射]。ACTH和皮质醇浓度在-15-120分钟内测定。与正常对照组相比，地塞米松不能完全抑制血浆促肾上腺皮质激素和血清皮质醇浓度[均值+/-扫描电子显微镜：血浆促肾上腺皮质激素，21+/-4pg/mLvs.3+/-0.5pm o l/m L(4.7+/-0.9vs.0.7+/-0.1pmol/L)；血清皮质醇，13.9+/-1.9vs.1.5+/-0.3微克/dL(390+/-50vs.40+/-10nmol/L)；P=0.0001]，显示出糖皮质激素反馈的改变。接受促肾上腺皮质激素释放激素刺激的患者平均基础血浆促肾上腺皮质激素和血清皮质醇浓度明显升高[促肾上腺皮质激素，78+/-20pg/mLvs.15+/-3；对照组(17.2+/-4.4vs.3.4+/-0.7pmol/L；P=0.007)；皮质醇，36.8+/-3.4微克/dL vs.9.6+/-1.2(1020+/-80vs.260+/-30nmol/L；P=0.0001)]。尽管基础糖皮质激素浓度升高，但hCRH刺激后15分钟血浆ACTH峰值浓度显著高于对照组[134+/-31pg/mLvs.48+/-9pg/mL29.5+/-6.8vs.10.6+/-2.0pmol/L]。在整个试验期间，ICU患者的血清皮质醇浓度显著升高(P=0.0001)，并上升到峰值43.9+/-3.5微克/dL，而对照组为18.2+/-2.0微克/dL(1210+/-70vs.500+/-60nmol/L)。我们的结论是，ICU患者对地塞米松抑制和hCRH刺激的垂体促肾上腺皮质激素的反应性有明显改变。这些发现可能是由于危重病期间脑下垂体糖皮质激素反馈改变和/或具有CRH样活性的多肽(加压素和细胞因子)过度分泌所致。
Plasma ACTH and cortisol concentrations are frequently elevated in patients in intensive care units (ICU). To examine the functional integrity of the hypothalamic-pituitary-adrenal axis during critical illness, we evaluated prospectively 53 ICU patients in a general medical ICU. Thirty-one patients and 7 normal controls underwent an overnight dexamethasone suppression test (3 mg dexamethasone, orally, at 2300 h). Plasma ACTH and serum cortisol were measured at 0900 h. In a separate experiment, 22 patients and 7 control subjects underwent a CRH stimulation test [100 micrograms human (h) CRH, iv]. ACTH and cortisol concentrations were determined from -15 to 120 min. Compared to normal controls, plasma ACTH and serum cortisol concentrations were not fully suppressible by dexamethasone [mean +/- SEM: plasma ACTH, 21 +/- 4 vs. 3 +/- 0.5 pg/mL (4.7 +/- 0.9 vs. 0.7 +/- 0.1 pmol/L); serum cortisol, 13.9 +/- 1.9 vs. 1.5 +/- 0.3 micrograms/dL (390 +/- 50 vs. 40 +/- 10 nmol/L); P = 0.0001], demonstrating an altered glucocorticoid feedback in the ICU patients. Patients undergoing hCRH stimulation had clearly elevated mean baseline plasma ACTH and serum cortisol concentrations [ACTH, 78 +/- 20 pg/mL vs. 15 +/- 3 in controls (17.2 +/- 4.4 vs. 3.4 +/- 0.7 pmol/L; P = 0.007); cortisol, 36.8 +/- 3.4 micrograms/dL vs. 9.6 +/- 1.2 (1020 +/- 80 vs. 260 +/- 30 nmol/L; P = 0.0001)]. Despite elevated baseline glucocorticoid concentrations, stimulation with hCRH resulted in significantly higher peak plasma ACTH concentrations 15 min after hCRH than in controls [134 +/- 31 vs. 48 +/- 9 pg/mL (29.5 +/- 6.8 vs. 10.6 +/- 2.0 pmol/L); P < 0.05]. Serum cortisol concentrations in ICU patients were significantly elevated throughout the test period (P = 0.0001) and rose to a peak of 43.9 +/- 3.5 micrograms/dL compared to 18.2 +/- 2.0 micrograms/dL in controls (1210 +/- 70 vs. 500 +/- 60 nmol/L). We conclude that ICU patients have a markedly altered responsiveness of their pituitary corticotroph to suppression with dexamethasone and stimulation with hCRH. These findings may be explained by altered pituitary glucocorticoid feedback and/or hypersecretion of peptides with CRH-like activity (vasopressin and cytokines) during critical illness.
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影响因子：
158.5
作者：
MICHIE, HR;MANOGUE, KR;WILMORE, DW
通讯作者：
WILMORE, DW
影响因子：
56.9
作者：
SAPOLSKY, R;RIVIER, C;VALE, W
通讯作者：
VALE, W
在严重非甲状腺疾病的低甲状腺素状态下抑制促甲状腺素。
DOI：
10.1056/nejm198502283120904
发表时间：
1985
期刊：
The New England journal of medicine
影响因子：
--
作者：
Wehmann,RE;Gregerman,RI;Burns,WH;Saral,R;Santos,GW
通讯作者：
Santos,GW
烧伤危重患者的血清恶病质素/肿瘤坏死因子与感染和死亡率相关。
DOI：
--
发表时间：
1990
期刊：
Surgery, gynecology & obstetrics
影响因子：
--
作者：
Marano,MA;Fong,Y;Moldawer,LL;Wei,H;Calvano,SE;Tracey,KJ;Barie,PS;Manogue,K;Cerami,A;Shires,GT
通讯作者：
Shires,GT
血管紧张素 II 和 ACTH 释放：相对于促肾上腺皮质激素释放因子和加压素的作用部位和效力。
影响因子：
4.1
作者：
Spinedi,E;Negro-Vilar,A
通讯作者：
Negro-Vilar,A