Intensive Care Medicine

, Volume 33, Issue 10, pp 1746–1753 | Cite as

Evidence of altered cortisol metabolism in critically ill patients: a prospective study

  • Bala Venkatesh
  • Jeremy Cohen
  • Ingrid Hickman
  • Janelle Nisbet
  • Peter Thomas
  • Gregory Ward
  • Jonathan Hall
  • John Prins



Changes in cortisol metabolism due to altered activity of the enzyme 11β-hydroxysteroid dehydrogenase (11β-HSD) have been implicated in the pathogenesis of hypertension, obesity and the metabolic syndrome. No published data exist on the activity of this enzyme in critical illness.


To investigate cortisol metabolism in critically ill patients utilising plasma cortisol: cortisone ratio as an index of 11β-HSD activity.


Tertiary level intensive care unit.


Three cohorts of critically ill patients: sepsis (n = 13); multitrauma (n = 20); and burns (n = 19).

Main outcome measures

Serial plasma cortisol: cortisone ratios.

Measurements and main results

Plasma total cortisol cortisone ratios were determined serially after admission to the intensive care unit. As compared with controls, the plasma cortisol:cortisone ratio was significantly elevated in the sepsis and trauma cohorts on day 1 (22 ± 9, p = 0.01, and 23 ± 19, p = 0.0003, respectively) and remained elevated over the study period. Such a relationship was not demonstrable in burns. The ratio was significantly correlated with APACHE II (r = 0.77, p = 0.0008) and Simplified Acute Physiology Score (r = 0.7, p = 0.003) only on day 7 and only in the burns cohort. There were no significant correlations observed between total plasma cortisol or cortisone and sickness severity in the sepsis and trauma cohorts.


In critically ill patients, there is evidence of altered cortisol metabolism due to an increase in 11β-HSD activity as demonstrated by an elevation of plasma cortisol: cortisone ratios. Further studies with larger sample sizes specifically designed to examine altered tissue 11β-HSD activity and its clinical significance and correlation with outcome are warranted.


11β-hydroxysteroid dehydrogenase Septic shock Trauma Burns Critical illness Cortisol–cortisone ratios 



This study was supported by grants from the Princess Alexandra Hospital Research Foundation and Australia and New Zealand College of Anaesthetists.


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bala Venkatesh
    • 1
  • Jeremy Cohen
    • 2
  • Ingrid Hickman
    • 3
  • Janelle Nisbet
    • 3
  • Peter Thomas
    • 2
  • Gregory Ward
    • 3
  • Jonathan Hall
    • 4
  • John Prins
    • 3
  1. 1.Department of Intensive Care, Princess Alexandra and Wesley HospitalsUniversity of QueenslandQueenslandAustralia
  2. 2.Department of Intensive Care, Royal Brisbane HospitalUniversity of QueenslandQueenslandAustralia
  3. 3.Department of Endocrinology, Princess Alexandra HospitalUniversity of QueenslandQueenslandAustralia
  4. 4.Division of Anesthesiology and Critical CareUniversity of QueenslandQueenslandAustralia

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