HORMONE CONCENTRATIONS TO ASSESS ADRENAL FUNCTION IN CRITICALLY ILL PATIENTS

用于评估危重患者肾上腺功能的激素浓度

• 批准号: 7378059
• 负责人: BAHA M ARAFAH
• 金额: $ 0.05万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7378059
• 关键词: HORMONE; CONCENTRATIONS; ASSESS; ADRENAL; FUNCTION

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Activation of the pituitary adrenal function during stressful events is a major physiological defense mechanism marked by elevated adrenocorticotropic hormone (ACTH) production and increased glucocorticoid secretion. Currently used measures to assess the integrity of the adrenal function rely on serum cortisol determinations. With the high degree of protein binding for cortisol in the circulation, its serum concentration is changed with alterations in these binding proteins. A recent study demonstrated that serum free cortisol levels are better markers for glucocorticoid secretion. This study will investigate the value of measuring salivary cortisol concentration as a marker for serum free cortisol level in critically ill adult patients. It will also study the value of measuring ACTH-dependent adrenal androgens (DHEA/DHEA-S) as markers for adrenal function in this population. The hypothesis is that salivary cortisol concentration strongly correlates with the serum free cortisol level and that such measurements would be a reliable and practical surrogate for glucocorticoid secretion in critically ill patients. This would be particularly important in patients with hypoproteinemia where measured total serum levels can be misleadingly low. The study will enroll 38 adult men and women in the intensive care unit and 19 healthy volunteers of similar age and gender distribution (a total of 57 subjects). Subjects will have a clinical assessment by the endocrine team to determine eligibility for study. Subjects will have one standard cortrosyn stimulation test involving blood and saliva collection. For all normal volunteers, this test will be conducted in an outpatient visit at the GCRC. The endocrine team will provide a written clinical evaluation of all patients involved in the study, including diagnostic and therapeutic recommendations pertinent to each patient's endocrine clinical assessment. The data obtained from this protocol will serve as a pilot study for a larger multi-center investigation evaluating these measures to define illness-specific adrenal responses.

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。应激事件中垂体肾上腺功能的激活是一种主要的生理防御机制，其特征是促肾上腺皮质激素（ACTH）分泌升高和糖皮质激素分泌增加。目前用于评估肾上腺功能完整性的措施依赖于血清皮质醇的测定。随着皮质醇在血液循环中的高度结合蛋白，其血清浓度随着这些结合蛋白的改变而改变。最近的一项研究表明，血清游离皮质醇水平是糖皮质激素分泌的较好标志物。本研究将探讨唾液皮质醇浓度作为危重成人患者血清游离皮质醇水平的标志物的价值。它还将研究测量acth依赖性肾上腺雄激素（DHEA/DHEA- s）作为该人群肾上腺功能标志物的价值。假设唾液皮质醇浓度与血清游离皮质醇水平密切相关，这种测量将是危重患者糖皮质激素分泌的可靠和实用的替代品。这对于低蛋白血症患者尤其重要，因为他们的血清总水平可能会低得令人误解。该研究将招募38名重症监护室的成年男女和19名年龄和性别分布相似的健康志愿者（共57名受试者）。受试者将由内分泌小组进行临床评估，以确定研究资格。受试者将进行一次标准的cortrosyn刺激测试包括采集血液和唾液。对于所有正常志愿者，该测试将在GCRC门诊进行。内分泌小组将为参与研究的所有患者提供书面临床评估，包括与每位患者的内分泌临床评估相关的诊断和治疗建议。从该方案中获得的数据将作为一个更大的多中心调查的试点研究，评估这些措施，以确定疾病特异性肾上腺反应。