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The Endocrine Response to Critical Illness

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Pediatric Endocrinology

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Abstract

The endocrine response to critical illness is composed of acute and chronic responses. The acute response is considered adaptive as a means of responding to physiologic stress. In this phase, stress stimulates the hypothalamic-pituitary-adrenal (HPA) axis, peripherally inactivates the hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) axes, increases secretion of growth hormone, and induces insulin resistance and protein catabolism. The concept, diagnosis, and treatment of critical illness-related corticosteroid insufficiency remain controversial. The chronic response to critical illness is marked by central suppression of the HPT, HPG, and GH axes. This phase is particularly notable for continued protein catabolism and insulin resistance associated with significant morbidity and mortality.

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Notes

  1. 1.

    This test is known as thyroid-binding globulin index (TBGI), thyroid hormone-binding resin (THBR), T3 resin uptake (T3RU), and free thyroxine index (FTI). The units and normal ranges of each version of the test are unique.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Katherine Ratzan Peeler MD

  2. Division of Medicine Critical Care, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Katherine Ratzan Peeler MD

  3. Harvard Medical School, Boston, MA, USA

    Michael S. D. Agus MD

  4. Division of Medicine Critical Care, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Michael S. D. Agus MD

  5. Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Michael S. D. Agus MD

Authors
  1. Katherine Ratzan Peeler MD
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  2. Michael S. D. Agus MD
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Correspondence to Michael S. D. Agus MD .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA

    Sally Radovick

  2. Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, Massachusetts, USA

    Madhusmita Misra

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Peeler, K.R., Agus, M.S.D. (2018). The Endocrine Response to Critical Illness. In: Radovick, S., Misra, M. (eds) Pediatric Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-73782-9_38

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  • DOI: https://doi.org/10.1007/978-3-319-73782-9_38

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