Hormonal Changes in Critical Condition

Abstract

Heung Bum Lee, M.D. and Chi Ryang Chung, M.D.Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea When disease or trauma progresses to a critical state, the reaction of the endocrine system in creating homeostasis is essential for survival. The association between the severity of hormonal changes and outcome in terms of morbid-ity and mortality has led to the challenge of development of several endocrine treatments. During sepsis, nitric ox-ide-mediated apoptosis is observed in the neurons and glial cells of the cerebrovascular centers of the autonomic nervous system. It is probably one of the components of the circulatory dysfunction of sepsis. The regulation of dif-ferent organs was neither linear nor independent however organs were found to behave as biological oscillators cou-pled to each other through neurological or hormonal communication pathways. Sepsis, because of systemic in-flammatory responsive syndrome, disrupts these communication pathways and leads to organ failures. Endocrine hor-monal issues related to the intensive care setting are common challenges to ICU specialists. Disruptions of the en-docrine system in sepsis are characterized by 1) an increase in cortisol plasma levels with a loss of the circadian rhythm of its secretion; 2) hyperglycemia due to insulin resistance and rise in hyperglycemic hormones secretion; 3) relative vasopressin deficiency; and 4) euthyroid sick syndrome or non-thyroidal illness syndrome. This article dis-cusses the dynamic changes of four main endocrine axes: hypothalamic-pituitary-adrenal axis, insulin, vasopressin and thyroid during grave states of disease, when a patient is in critical condition.KeyWords:adrenal insufficiency, cortisol, critical illness, hyperglycemia, thyroid.논문접수일：2010년 9월 15일, 승인일：2010년 9월 15일책임저자：이흥범, 전북 전주시 덕진구 금암동 산 2-20전북대학교 의과대학 내과학교실우편번호: 561-180Tel: 063-250-1685, Fax: 063-250-1609E-mail: lhbmd@jbnu.ac.kr