Abstract
Sepsis is characterised by marked derangement of hormonal profiles resulting from stress related activation of the hypothalamic and pituitary glands. Subsequently, serum cortisol levels are usually increased in relation to the severity of the systemic inflammatory response. However, about 50% of patients with severe sepsis present with adrenal insufficiency and a poor prognosis. This condition can be diagnosed using a standard short corticotropin test and may be reversed by cortisol replacement. Similarly, blood glucose levels are increased at the very early phase of septic shock and hyperglycaemia is associated with increased morbid-mortality. It results mainly from tissues resistance to insulin, and enhanced synthesis of the counter-regulatory hormones. Nevertheless, hypoglycaemic episodes are frequent in the late phase of septic shock and also carries a poor prognosis. The euthyroid sick syndrome is characterised by lack of active circulating hormones. Its mechanisms are poorly understood and there is no evidence for any benefit from thyroid hormones substitution in septic shock. Finally, vasopressin may also be decreased during septic shock, mostly at the late course of the disease. The role of vasopressin replacement therapy is currently under investigation.
Published Version
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