Abstract
ObjectiveThe neuroendocrine response to critical illness is dichotomous as it is adaptive during the acute phase then transitions to maladaptive as critical illness becomes prolonged in 25-30% of patients. Presently, monitoring all critically ill patients for endocrinopathies is not the standard of care. However, given the negative impact on patient prognosis, a need to identify those at risk for endocrinopathies, may exist. Thus, a screening tool to identify endocrinopathies along the somatotroph and gonadal axes in a cardiothoracic surgery population was developed.MethodsA prospective observational pilot study was conducted in two cardiothoracic surgery intensive care units (ICU) within a multi-site healthcare system. Total testosterone and somatomedin C levels were obtained from 20 adult patients who remained in the ICU for greater than seven days after cardiothoracic surgery and were tolerating nutrition, had a risk of malnutrition and a mobility score of moderate to dependent assistance.ResultsTwenty patients were included for descriptive analysis (seven females). Thirteen patients tested low for total testosterone, with males more likely to have a testosterone-related endocrinopathy as compared to females (100% vs. 0 to 43%, p = 0.0072). A higher proportion of low somatomedin C levels was found in females than males (57% vs. 31%); however, the difference was not statistically significant (p = 0.251).ConclusionsThe screening tool used in this pilot study accurately predicted low total testosterone in all men and reasonably predicted low somatomedin C in a majority of women. However, the ability of the tool to predict low total testosterone in women and low somatomedin C in men is less certain. A gender-specific screening tool might be necessary to predict hormonal deficiencies.
Highlights
Significant research and subsequent advances in the management of critically ill patients has expedited the time to recovery and discharge from the intensive care unit (ICU) for a vast number of patients
The neuroendocrine response to critical illness is dichotomous as it is adaptive during the acute phase transitions to maladaptive as critical illness becomes prolonged in 25-30% of patients
Total testosterone and somatomedin C levels were obtained from 20 adult patients who remained in the ICU for greater than seven days after cardiothoracic surgery and were tolerating nutrition, had a risk of malnutrition and a mobility score of moderate to dependent assistance
Summary
Significant research and subsequent advances in the management of critically ill patients has expedited the time to recovery and discharge from the intensive care unit (ICU) for a vast number of patients. 2530% of ICU patients transition to a chronic phase of critical illness in which the stress-mediated neuroendocrine response becomes maladaptive [1,2,3,4]. In addition to loss of lean muscle mass, chronic critical illness is defined as prolonged mechanical ventilation, development of myopathy and/or polyneuropathy, increased infectious complications, poor wound healing and the presence of endocrinopathy [1,2,6,7,8,9]. The neuroendocrine response to critical illness via the hypothalamic-pituitary axis (HPA) is biphasic (acute and chronic) and involves dysregulation of both the somatotroph and gonadal axes [1,2,4,10]. Growth hormone (GH), or somatotropin, is a large polypeptide that is essential for both direct and indirect metabolic
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
