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Endokrine Störungen bei kritisch Kranken

Endocrine disturbances in the critically ill

  • ÜBERSICHT
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Intensivmedizin und Notfallmedizin

Summary

During critical illness, profound changes in endocrine homeostasis occur. Initially, peripheral hormones are being inactivated while the hypothalamic-pituitary axis are activated. In prolonged illness, the anterior pituitary function is reduced. While the initial inactivation of peripheral hormones are usually seen as beneficial adaptive mechanisms to reduce oxygen consumption, the later process of pituitary insufficiency might be a maladaptive process, thereby aggravating the clinical course of the disease. This review focuses on the current pathophysiology and possible therapies of endocrine disturbances in critical ill patients. The pathophysiology of the relative adrenal insufficiency and therapy concepts with steroids are discussed. The outcome of patients receiving growth hormone treatment are elucidated, and the pathophysiology of gonadal insufficiency are demonstrated. The etiology of the nonthyroidal illness syndrome (NTIS) as well as potential treatment options are shown. Finally, the impact of intensified glucose control in critical ill patients will be discussed.

Zusammenfassung

Bei kritisch kranken Patienten kommt es im Rahmen der intensivpflichtigen Erkrankung häufig zu Veränderungen der endokrinen Funktionen. Initial werden bei erhöhten hypothalamisch-hypophysären Hormonspiegeln die peripheren Hormone inaktiviert. Im Weiteren Verlauf der Erkrankung kann schließlich eine Verminderung der hypothalamisch-hypophysären Funktionen beobachtet werden. Während die initiale Inaktivierung der peripheren Hormone meist als adaptiver Prozess zur Verminderung des Sauerstoffverbrauchs angesehen wird, könnte die folgende Insuffizienz der zentralen Anteile der Hormonachsen einen maladaptiven Prozess darstellen, der den klinischen Verlauf der Erkrankung negativ beeinflusst. In dieser Übersicht werden aktuelle pathophysiologische Konzepte und mögliche Therapiestrategien endokriner Störungen bei kritisch Kranken dargestellt. Dabei werden pathophysiologische Aspekte der relativen Nebenniereninsuffizienz sowie therapeutische Konzepte mittels Steroidsubstitution diskutiert. Der Einfluss einer Therapie mit Wachstumshormonen ebenso wie pathophysiologische Hintergründe der gonadalen Insuffizienz werden aufgezeigt. Einen weiteren Schwerpunkt bilden Veränderungen der Schilddrüsenhormone im Sinne eines NTIS (nonthyroidal illness syndrome). Schließlich werden wesentliche Aspekte der Blutzuckereinstellung bei kritisch kranken Patienten diskutiert.

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References

  1. Angele MK, Ayala A, Cioffi WG, Bland KI, Chaudry IH (1998) Testosterone: the culprit for producing splenocyte immune depression after trauma hemorrhage. Am J Physiol 274:C1530–1536

    PubMed  CAS  Google Scholar 

  2. Angele MK, Wichmann MW, Ayala A, Cioffi WG, Chaudry IH (1997) Testosterone receptor blockade after hemorrhage in males. Restoration of the depressed immune functions and improved survival following subsequent sepsis. Arch Surg 132:1207–1214

    PubMed  CAS  Google Scholar 

  3. Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. Jama 288:862–871

    Article  PubMed  CAS  Google Scholar 

  4. Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E (2000) A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. Jama 283:1038–1045

    Article  PubMed  CAS  Google Scholar 

  5. Aono T, Kurachi K, Mizutani S, Hamanaka Y, Uozumi T, Nakasima A, Koshiyama K, Matsumoto K (1972) Influence of major surgical stress on plasma levels of testosterone, luteinizing hormone and follicle-stimulating hormone in male patients. J Clin Endocrinol Metab 35:535–542

    PubMed  CAS  Google Scholar 

  6. Aygen B, Inan M, Doganay M, Kelestimur F (1997) Adrenal functions in patients with sepsis. Exp Clin Endocrinol Diabetes 105:182–186

    PubMed  CAS  Google Scholar 

  7. Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM (2003) Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 34:2208–2214

    Article  PubMed  CAS  Google Scholar 

  8. Barle H, Essen P, Nyberg B, Olivecrona H, Tally M, McNurlan MA, Wernerman J, Garlick PJ (1999) Depression of liver protein synthesis during surgery is prevented by growth hormone. Am J Physiol 276:E620–627

    PubMed  CAS  Google Scholar 

  9. Barry MC, Mealy K, Sheehan SJ, Burke PE, Cunningham AJ, Leahy A, Bouchier Hayes D (1998) The effects of recombinant human growth hormone on cardiopulmonary function in elective abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 16:311–319

    Article  PubMed  CAS  Google Scholar 

  10. Barton RN, Stoner HB, Watson SM (1987) Relationships among plasma cortisol, adrenocorticotrophin, and severity of injury in recently injured patients. J Trauma 27:384–392

    PubMed  CAS  Google Scholar 

  11. Becker RA, Vaughan GM, Ziegler MG, Seraile LG, Goldfarb IW, Mansour EH, McManus WF, Pruitt BA, Jr., Mason AD Jr (1982) Hypermetabolic low triiodothyronine syndrome of burn injury. Crit Care Med 10:870–875

    Article  PubMed  CAS  Google Scholar 

  12. Beishuizen A, van Lijf JH, Lekkerkerker JF, Vermes I (2000) The low dose (1 microg) ACTH stimulation test for assessment of the hypothalamo-pituitary-adrenal axis. Neth J Med 56:91–99

    Article  PubMed  CAS  Google Scholar 

  13. Bethin KE, Vogt SK, Muglia LJ (2000) Interleukin-6 is an essential, corticotropin-releasing hormone-independent stimulator of the adrenal axis during immune system activation. Proc Natl Acad Sci USA 97:9317–9322

    Article  PubMed  CAS  Google Scholar 

  14. Brent GA, Hershman JM (1986) Thyroxine therapy in patients with severe nonthyroidal illnesses and low serum thyroxine concentration. J Clin Endocrinol Metab 63:1–8

    Article  PubMed  CAS  Google Scholar 

  15. Briegel J (2003) Kortisonsubstitution bei Sepsis. Ist weniger mehr? Anaesthesist 52(Suppl 1):S24–31

    Article  PubMed  Google Scholar 

  16. Briegel J, Schelling G, Haller M, Mraz W, Forst H, Peter K (1996) A comparison of the adrenocortical response during septic shock and after complete recovery. Intensive Care Med 22:894–899

    Article  PubMed  CAS  Google Scholar 

  17. Burman KD, Wartofsky L (2000) Iodine effects on the thyroid gland: biochemical and clinical aspects. Rev Endocr Metab Disord 1:19–25

    Article  PubMed  CAS  Google Scholar 

  18. Capes SE, Hunt D, Malmberg K, Gerstein HC (2000) Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 355:773–778

    Article  PubMed  CAS  Google Scholar 

  19. Carr FE, Shupnik MA, Burnside J, Chin WW (1989) Thyrotropin-releasing hormone stimulates the activity of the rat thyrotropin beta-subunit gene promoter transfected into pituitary cells. Mol Endocrinol 3:717–724

    PubMed  CAS  Google Scholar 

  20. Chow CC, Mak TW, Chan CH, Cockram CS (1995) Euthyroid sick syndrome in pulmonary tuberculosis before and after treatment. Ann Clin Biochem 32(Pt 4):385–391

    PubMed  Google Scholar 

  21. Christeff N, Auclair MC, Thobie N, Fertil B, Carli A, Nunez EA (1994) Effect of estradiol on endotoxin-induced changes in steroid hormone levels and lethality in male rats. Circ Shock 44:154–159

    PubMed  CAS  Google Scholar 

  22. Christeff N, Benassayag C, Carli-Vielle C, Carli A, Nunez EA (1988) Elevated oestrogen and reduced testosterone levels in the serum of male septic shock patients. J Steroid Biochem 29:435–440

    Article  PubMed  CAS  Google Scholar 

  23. Christiansen C, Toft P, Jorgensen HS, Andersen SK, Tonnesen E (2004) Hyperglycaemia and mortality in critically ill patients A prospective study. Intensive Care Med 30:1685–1688

    Article  PubMed  Google Scholar 

  24. Chrysopoulo MT, Jeschke MG, Ramirez RJ, Barrow RE, Herndon DN (1999) Growth hormone attenuates tumor necrosis factor alpha in burned children. Arch Surg 134:283–286

    Article  PubMed  CAS  Google Scholar 

  25. Cittadini A, Stromer H, Katz SE, Clark R, Moses AC, Morgan JP, Douglas PS (1996) Differential cardiac effects of growth hormone and insulin-like growth factor-1 in the rat. A combined in vivo and in vitro evaluation. Circulation 93:800–809

    PubMed  CAS  Google Scholar 

  26. Claussen MS, Landercasper J, Cogbill TH (1992) Acute adrenal insufficiency presenting as shock after trauma and surgery: three cases and review of the literature. J Trauma 32:94–100

    PubMed  CAS  Google Scholar 

  27. Clemmons DR, Smith-Banks A, Underwood LE (1992) Reversal of dietinduced catabolism by infusion of recombinant insulin-like growth factor-I in humans. J Clin Endocrinol Metab 75:234–238

    Article  PubMed  CAS  Google Scholar 

  28. Corcoran C, Grinspoon S (1999) Treatments for wasting in patients with the acquired immunodeficiency syndrome. N Engl J Med 340:1740–1750

    Article  PubMed  CAS  Google Scholar 

  29. De Groot LJ (1999) Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 84:151–164

    Article  PubMed  CAS  Google Scholar 

  30. De La Vieja A, Dohan O, Levy O, Carrasco N (2000) Molecular analysis of the sodium/iodide symporter: impact on thyroid and extrathyroid pathophysiology. Physiol Rev 80:1083–1105

    PubMed  CAS  Google Scholar 

  31. Defalque D, Brandt N, Ketelslegers JM, Thissen JP (1999) GH insensitivity induced by endotoxin injection is associated with decreased liver GH receptors. Am J Physiol 276:E565–572

    PubMed  CAS  Google Scholar 

  32. del Aguila LF, Claffey KP, Kirwan JP (1999) TNF-alpha impairs insulin signaling and insulin stimulation of glucose uptake in C2C12 muscle cells. Am J Physiol 276:E849–855

    PubMed  CAS  Google Scholar 

  33. Demling RH (1999) Comparison of the anabolic effects and complications of human growth hormone and the testosterone analog, oxandrolone, after severe burn injury. Burns 25:215–221

    Article  PubMed  CAS  Google Scholar 

  34. Demling RH, DeSanti L (2001) The rate of restoration of body weight after burn injury, using the anabolic agent oxandrolone, is not age dependent. Burns 27:46–51

    Article  PubMed  CAS  Google Scholar 

  35. Dickstein G, Shechner C, Nicholson WE, Rosner I, Shen-Orr Z, Adawi F, Lahav M (1991) Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test. J Clin Endocrinol Metab 72:773–778

    PubMed  CAS  Google Scholar 

  36. Dillmann WH (2002) Cellular action of thyroid hormone on the heart. Thyroid 12:447–452

    Article  PubMed  CAS  Google Scholar 

  37. Ellis KJ, Lee PD, Pivarnik JM, Bukar JG, Gesundheit N (1996) Changes in body composition of human immunodeficiency virus-infected males receiving insulin-like growth factor I and growth hormone. J Clin Endocrinol Metab 81:3033–3038

    Article  PubMed  CAS  Google Scholar 

  38. Fan J, Gong XQ, Wu J, Zhang YF, Xu RB (1994) Effect of glucocorticoid receptor (GR) blockade on endotoxemia in rats. Circ Shock 42:76–82

    PubMed  CAS  Google Scholar 

  39. Fazio S, Sabatini D, Capaldo B, Vigorito C, Giordano A, Guida R, Pardo F, Biondi B, Sacca L (1996) A preliminary study of growth hormone in the treatment of dilated cardiomyopathy. N Engl J Med 334:809–814

    Article  PubMed  CAS  Google Scholar 

  40. Finney SJ, Zekveld C, Elia A, Evans TW (2003) Glucose control and mortality in critically ill patients. Jama 290:2041–2047

    Article  PubMed  CAS  Google Scholar 

  41. Fliers E, Alkemade A, Wiersinga WM (2001) The hypothalamic-pituitarythyroid axis in critical illness. Best Pract Res Clin Endocrinol Metab 15:453–464

    Article  PubMed  CAS  Google Scholar 

  42. Fliers E, Guldenaar SE, Wiersinga WM, Swaab DF (1997) Decreased hypothalamic thyrotropin-releasing hormone gene expression in patients with nonthyroidal illness. J Clin Endocrinol Metab 82:4032–4036

    Article  PubMed  CAS  Google Scholar 

  43. Florini JR, Ewton DZ, Coolican SA (1996) Growth hormone and the insulin-like growth factor system in myogenesis. Endocr Rev 17:481–517

    Article  PubMed  CAS  Google Scholar 

  44. Frayn KN, Little RA, Maycock PF, Stoner HB (1985) The relationship of plasma catecholamines to acute metabolic and hormonal responses to injury in man. Circ Shock 16:229–240

    PubMed  CAS  Google Scholar 

  45. Frustaci A, Perrone GA, Gentiloni N, Russo MA (1992) Reversible dilated cardiomyopathy due to growth hormone deficiency. Am J Clin Pathol 97:503–511

    PubMed  CAS  Google Scholar 

  46. Gilpin DA, Barrow RE, Rutan RL, Broemeling L, Herndon DN (1994) Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. Ann Surg 220:19–24

    Article  PubMed  CAS  Google Scholar 

  47. Goldberg PA, Siegel MD, Sherwin RS, Halickman JI, Lee M, Bailey VA, Lee SL, Dziura JD, Inzucchi SE (2004) Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care 27:461–467

    Article  PubMed  CAS  Google Scholar 

  48. Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M (2001) Association of hyperglycemia with increased mortality after severe burn injury. J Trauma 51:540–544

    Article  PubMed  CAS  Google Scholar 

  49. Grinspoon S, Corcoran C, Parlman K, Costello M, Rosenthal D, Anderson E, Stanley T, Schoenfeld D, Burrows B, Hayden D, Basgoz N, Klibanski A (2000) Effects of testosterone and progressive resistance training in eugonadal men with AIDS wasting. A randomized, controlled trial. Ann Intern Med 133:348–355

    PubMed  CAS  Google Scholar 

  50. Halabe Cherem J, Nellen Hummel H, Gordon Barabejski F, Chong Martinez BA, Lifshitz Guinzberg A (1992) Thyroid function and abdominal surgery. A longitudinal study. Arch Med Res 23:143–147

    PubMed  CAS  Google Scholar 

  51. Hamrahian AH, Oseni TS, Arafah BM (2004) Measurements of serum free cortisol in critically ill patients. N Engl J Med 350:1629–1638

    Article  PubMed  CAS  Google Scholar 

  52. Hawker FH, Stewart PM, Baxter RC, Borkmann M, Tan K, Caterson ID, McWilliam DB (1987) Relationship of somatomedin-C/insulin-like growth factor I levels to conventional nutritional indices in critically ill patients. Crit Care Med 15:732–736

    Article  PubMed  CAS  Google Scholar 

  53. Herndon DN, Tompkins RG (2004) Support of the metabolic response to burn injury. Lancet 363:1895–1902

    Article  PubMed  CAS  Google Scholar 

  54. Hinshaw LB, Archer LT, Beller-Todd BK, Benjamin B, Flournoy DJ, Passey R (1981) Survival of primates in lethal septic shock following delayed treatment with steroid. Circ Shock 8:291–300

    PubMed  CAS  Google Scholar 

  55. Hoberman JM, Yesalis CE (1995) The history of synthetic testosterone. Sci Am 272:76–81

    Article  PubMed  CAS  Google Scholar 

  56. Holland FW, 2nd, Brown PS, Jr, Weintraub BD, Clark RE (1991) Cardiopulmonary bypass and thyroid function: a “euthyroid sick syndrome”. Ann Thorac Surg 52:46–50

    Article  PubMed  Google Scholar 

  57. Huang ZH, Gao H, Xu RB (1987) Study on glucocorticoid receptors during intestinal ischemia shock and septic shock. Circ Shock 23:27–36

    PubMed  CAS  Google Scholar 

  58. Hugues JN, Burger AG, Pekary AE, Hershman JM (1984) Rapid adaptations of serum thyrotrophin, triiodothyronine and reverse triiodothyronine levels to short-term starvation and refeeding. Acta Endocrinol (Copenh) 105:194–199

    PubMed  CAS  Google Scholar 

  59. Jaattela M, Ilvesmaki V, Voutilainen R, Stenman UH, Saksela E (1991) Tumor necrosis factor as a potent inhibitor of adrenocorticotropin-induced cortisol production and steroidogenic P450 enzyme gene expression in cultured human fetal adrenal cells. Endocrinology 128:623–629

    PubMed  CAS  Google Scholar 

  60. Jeschke MG, Einspanier R, Klein D, Jauch KW (2002) Insulin attenuates the systemic inflammatory response to thermal trauma. Mol Med 8:443–450

    PubMed  CAS  Google Scholar 

  61. Jiang ZM, He GZ, Zhang SY, Wang XR, Yang NF, Zhu Y, Wilmore DW (1989) Low-dose growth hormone and hypocaloric nutrition attenuate the protein-catabolic response after major operation. Ann Surg 210:513–524; discussion 524–515

    Article  PubMed  CAS  Google Scholar 

  62. Jurney TH, Cockrell JL Jr, Lindberg JS, Lamiell JM, Wade CE (1987) Spectrum of serum cortisol response to ACTH in ICU patients. Correlation with degree of illness and mortality. Chest 92:292–295

    Article  PubMed  CAS  Google Scholar 

  63. Kang SS, Kim SR, Leonhardt S, Jarry H, Wuttke W, Kim K (2000) Effect of interleukin-1β on gonadotropin-releasing hormone (GnRH) and GnRH receptor gene expression in castrated male rats. J Neuroendocrinol 12:421–429

    Article  PubMed  CAS  Google Scholar 

  64. Kanji S, Singh A, Tierney M, Meggison H, McIntyre L, Hebert PC (2004) Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 30:804–810

    Article  PubMed  Google Scholar 

  65. Kaptein EM, Robinson WJ, Grieb DA, Nicoloff JT (1982) Peripheral serum thyroxine, triiodothyronine and reverse triiodothyronine kinetics in the low thyroxine state of acute nonthyroidal illnesses. A noncompartmental analysis. J Clin Invest 69:526–535

    Article  PubMed  CAS  Google Scholar 

  66. Kelley KW (1990) The role of growth hormone in modulation of the immune response. Ann NY Acad Sci 594:95–103

    Article  PubMed  CAS  Google Scholar 

  67. Klemperer JD, Klein I, Gomez M, Helm RE, Ojamaa K, Thomas SJ, Isom OW, Krieger K (1995) Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med 333:1522–1527

    Article  PubMed  CAS  Google Scholar 

  68. Kohn LD, Suzuki K, Nakazato M, Royaux I, Green ED (2001) Effects of thyroglobulin and pendrin on iodide flux through the thyrocyte. Trends Endocrinol Metab 12:10–16

    Article  PubMed  CAS  Google Scholar 

  69. Köhrle J (1999) Local activation and inactivation of thyroid hormones: the deiodinase family. Mol Cell Endocrinol 151:103–119

    Article  PubMed  Google Scholar 

  70. Lackey BR, Gray SL, Henricks DM (1999) The insulin-like growth factor (IGF) system and gonadotropin regulation: actions and interactions. Cytokine Growth Factor Rev 10:201–217

    Article  PubMed  CAS  Google Scholar 

  71. Lamberts SW, Bruining HA, de Jong FH (1997) Corticosteroid therapy in severe illness. N Engl J Med 337:1285–1292

    Article  PubMed  CAS  Google Scholar 

  72. Ledingham IM, Watt I (1983) Influence of sedation on mortality in critically ill multiple trauma patients. Lancet 1:1270

    Article  PubMed  CAS  Google Scholar 

  73. Lind L, Lithell H (1994) Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival. Clin Intensive Care 5:100–105

    PubMed  CAS  Google Scholar 

  74. Lueprasitsakul P, Longcope C (1991) Aromatase activity in human adipose tissue stromal cells; the effect of fetal bovine serum fractions on dexamethasone-stimulated aromatization. J Steroid Biochem Mol Biol 39:353–357

    Article  PubMed  CAS  Google Scholar 

  75. Malmberg K, Norhammar A, Wedel H, Ryden L (1999) Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 99:2626–2632

    PubMed  CAS  Google Scholar 

  76. Matot I, Sprung CL (1998) Corticosteroids in septic shock: resurrection of the last rites? Crit Care Med 26:627–630

    Article  PubMed  CAS  Google Scholar 

  77. May ME, Carey RM (1985) Rapid adrenocorticotropic hormone test in practice. Retrospective review. Am J Med 79:679–684

    Article  PubMed  CAS  Google Scholar 

  78. Miell JP, Taylor AM, Jones J, Buchanan CR, Rennie J, Sherwood R, Leicester R, Ross RJ (1992) Administration of human recombinant insulinlike growth factor-I to patients following major gastrointestinal surgery. Clin Endocrinol (Oxf) 37:542–551

    Article  CAS  Google Scholar 

  79. Mizock BA (2001) Alterations in fuel metabolism in critical illness: hyperglycaemia. Best Pract Res Clin Endocrinol Metab 15:533–551

    Article  PubMed  CAS  Google Scholar 

  80. Mjaaland M, Unneberg K, Larsson J, Nilsson L, Revhaug A (1993) Growth hormone after abdominal surgery attenuated forearm glutamine, alanine, 3-methylhistidine, and total amino acid efflux in patients receiving total parenteral nutrition. Ann Surg 217:413–422

    Article  PubMed  CAS  Google Scholar 

  81. Mönig H, Arendt T, Meyer M, Kloehn S, Bewig B (1999) Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases-implications for the euthyroid sick syndrome. Intensive Care Med 25:1402–1406

    Article  PubMed  Google Scholar 

  82. Moran JL, Chapman MJ, O’Fathartaigh MS, Peisach AR, Pannall PR, Leppard P (1994) Hypocortisolaemia and adrenocortical responsiveness at onset of septic shock. Intensive Care Med 20:489–495

    Article  PubMed  CAS  Google Scholar 

  83. Mulligan K, Schambelan M (2002) Anabolic treatment with GH, IGF-I, or anabolic steroids in patients with HIV-associated wasting. Int J Cardiol 85:151–159

    Article  PubMed  Google Scholar 

  84. Nakashima A, Koshiyama K, Uozumi T, Monden Y, Hamanaka Y (1975) Effects of general anaesthesia and severity of surgical stress on serum LH and testosterone in males. Acta Endocrinol 78:258–269

    PubMed  CAS  Google Scholar 

  85. Oehri M, Ninnis R, Girard J, Frey FJ, Keller U (1996) Effects of growth hormone and IGF-I on glucocorticoid-induced protein catabolism in humans. Am J Physiol 270:E552–558

    PubMed  CAS  Google Scholar 

  86. Olster DH, Ferin M (1987) Corticotropin-releasing hormone inhibits gonadotropin secretion in the ovariectomized rhesus monkey. J Clin Endocrinol Metab 65:262–267

    PubMed  CAS  Google Scholar 

  87. Orava M, Cantell K, Vihko R (1986) Treatment with preparations of human leukocyte interferon decreases serum testosterone concentrations in men. Int J Cancer 38:295–296

    Article  PubMed  CAS  Google Scholar 

  88. Pagliassotti MJ, Moore MC, Neal DW, Cherrington AD (1992) Insulin is required for the liver to respond to intraportal glucose delivery in the conscious dog. Diabetes 41:1247–1256

    Article  PubMed  CAS  Google Scholar 

  89. Patel SR, Selby C, Jeffcoate WJ (1991) The short Synacthen test in acute hospital admissions. Clin Endocrinol 35:259–261

    Article  CAS  Google Scholar 

  90. Ponting GA, Ward HC, Halliday D, Sim AJ (1990) Protein and energy metabolism with biosynthetic human growth hormone in patients on full intravenous nutritional support. JPEN J Parenter Enteral Nutr 14:437–441

    Article  PubMed  CAS  Google Scholar 

  91. Pugeat M, Bonneton A, Perrot D, Rocle-Nicolas B, Lejeune H, Grenot C, Dechaud H, Brebant C, Motin J, Cuilleron CY (1989) Decreased immunoreactivity and binding activity of corticosteroid-binding globulin in serum in septic shock. Clin Chem 35:1675–1679

    PubMed  CAS  Google Scholar 

  92. Ramirez RJ, Wolf SE, Barrow RE, Herndon DN (1998) Growth hormone treatment in pediatric burns: a safe therapeutic approach. Ann Surg 228:439–448

    Article  PubMed  CAS  Google Scholar 

  93. Ross R, Miell J, Freeman E, Jones J, Matthews D, Preece M, Buchanan C (1991) Critically ill patients have high basal growth hormone levels with attenuated oscillatory activity associated with low levels of insulin-like growth factor-I. Clin Endocrinol 35:47–54

    Article  CAS  Google Scholar 

  94. Rothwell PM, Udwadia ZF, Lawler PG (1991) Cortisol response to corticotropin and survival in septic shock. Lancet 337:582–583

    Article  PubMed  CAS  Google Scholar 

  95. Saeed M, Carlson GL, Little RA, Irving MH (1999) Selective impairment of glucose storage in human sepsis. Br J Surg 86:813–821

    Article  PubMed  CAS  Google Scholar 

  96. Savu L, Zouaghi H, Carli A, Nunez EA (1981) Serum depletion of corticosteroid binding activities, an early marker of human septic shock. Biochem Biophys Res Commun 102:411–419

    Article  PubMed  CAS  Google Scholar 

  97. Scanlan TS, Suchland KL, Hart ME, Chiellini G, Huang Y, Kruzich PJ, Frascarelli S, Crossley DA, Bunzow JR, Ronca-Testoni S, Lin ET, Hatton D, Zucchi R, Grandy DK (2004) 3-Iodothyronamine is an endogenous and rapid-acting derivative of thyroid hormone. Nat Med 10:638–642

    Article  PubMed  CAS  Google Scholar 

  98. Semple CG, Mitchell R, Hollis S, Robertson WR (1992) An investigation of LH pulsatility in burned men by bioassay and radioimmunoassay. Acta Endocrinol 126:404–409

    PubMed  CAS  Google Scholar 

  99. Shen YT, Woltmann RF, Appleby S, Prahalada S, Krause SM, Kivilghn SD, Johnson RG, Siegl PK, Lynch JJ (1998) Lack of beneficial effects of growth hormone treatment in conscious dogs during development of heart failure. Am J Physiol 274:H456–466

    PubMed  CAS  Google Scholar 

  100. Shupnik MA, Greenspan SL, Ridgway EC (1986) Transcriptional regulation of thyrotropin subunit genes by thyrotropin-releasing hormone and dopamine in pituitary cell culture. J Biol Chem 261:12675–12679

    PubMed  CAS  Google Scholar 

  101. Slag MF, Morley JE, Elson MK, Crowson TW, Nuttall FQ, Shafer RB (1981) Hypothyroxinemia in critically ill patients as a predictor of high mortality. Jama 245:43–45

    Article  PubMed  CAS  Google Scholar 

  102. Spratt DI, Bigos ST, Beitins I, Cox P, Longcope C, Orav J (1992) Both hyper-and hypogonadotropic hypogonadism occur transiently in acute illness: bio- and immunoactive gonadotropins. J Clin Endocrinol Metab 75:1562–1570

    Article  PubMed  CAS  Google Scholar 

  103. Spratt DI, Longcope C, Cox PM, Bigos ST, Wilbur-Welling C (1993) Differential changes in serum concentrations of androgens and estrogens (in relation with cortisol) in postmenopausal women with acute illness. J Clin Endocrinol Metab 76:1542–1547

    Article  PubMed  CAS  Google Scholar 

  104. Sprung CL, Caralis PV, Marcial EH, Pierce M, Gelbard MA, Long WM, Duncan RC, Tendler MD, Karpf M (1984) The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med 311:1137–1143

    Article  PubMed  CAS  Google Scholar 

  105. Stocco DM, Clark BJ (1996) Regulation of the acute production of steroids in steroidogenic cells. Endocr Rev 17:221–244

    Article  PubMed  CAS  Google Scholar 

  106. Surks MI, Sievert R (1995) Drugs and thyroid function. N Engl J Med 333:1688–1694

    Article  PubMed  CAS  Google Scholar 

  107. Takala J, Ruokonen E, Webster NR, Nielsen MS, Zandstra DF, Vundelinckx G, Hinds CJ (1999) Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 341:785–792

    Article  PubMed  CAS  Google Scholar 

  108. Tominaga T, Fukata J, Hayashi Y, Satoh Y, Fuse N, Segawa H, Ebisui O, Nakai Y, Osamura Y, Imura H (1992) Distribution and characterization of immunoreactive corticostatin in the hypothalamic-pituitary-adrenal axis. Endocrinology 130:1593–1598

    Article  PubMed  CAS  Google Scholar 

  109. Tsigos C, Papanicolaou DA, Kyrou I, Raptis SA, Chrousos GP (1999) Dose-dependent effects of recombinant human interleukin-6 on the pituitary-testicular axis. J Interferon Cytokine Res 19:1271–1276

    Article  PubMed  CAS  Google Scholar 

  110. Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE (2002) Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87:978–982

    Article  PubMed  CAS  Google Scholar 

  111. van den Berghe G, de Zegher F (1996) Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 24:1580–1590

    Article  PubMed  CAS  Google Scholar 

  112. van den Berghe G, Weekers F, Baxter RC, Wouters P, Iranmanesh A, Bouillon R, Veldhuis JD (2001) Five-day pulsatile gonadotropin-releasing hormone administration unveils combined hypothalamic-pituitary-gonadal defects underlying profound hypoandrogenism in men with prolonged critical illness. J Clin Endocrinol Metab 86:3217–3226

    Article  PubMed  CAS  Google Scholar 

  113. van den Berghe G, Wouters P, Weekers F, Mohan S, Baxter RC, Veldhuis JD, Bowers CY, Bouillon R (1999) Reactivation of pituitary hormone release and metabolic improvement by infusion of growth hormone-releasing peptide and thyrotropin-releasing hormone in patients with protracted critical illness. J Clin Endocrinol Metab 84:1311–1323

    Article  PubMed  CAS  Google Scholar 

  114. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367

    Article  PubMed  CAS  Google Scholar 

  115. van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P (2003) Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med 31:359–366

    Article  PubMed  CAS  Google Scholar 

  116. van den Berghe GH (1998) Acute and prolonged critical illness are two distinct neuroendocrine paradigms. Verh K Acad Geneeskd Belg 60:487–518; discussion 518–420

    PubMed  CAS  Google Scholar 

  117. Vexiau P, Perez-Castiglioni P, Socie G, Devergie A, Toubert ME, Aractingi S, Gluckman E (1993) The ‘euthyroid sick syndrome’: incidence, risk factors and prognostic value soon after allogeneic bone marrow transplantation. Br J Haematol 85:778–782

    Article  PubMed  CAS  Google Scholar 

  118. Vogel AV, Peake GT, Rada RT (1985) Pituitary-testicular axis dysfunction in burned men. J Clin Endocrinol Metab 60:658–665

    Article  PubMed  CAS  Google Scholar 

  119. Wang C, Chan V, Tse TF, Yeung RT (1978) Effect of acute myocardial infarction on pituitary-testicular function. Clin Endocrinol 9:249–253

    Article  CAS  Google Scholar 

  120. Wass CT, Lanier WL (1996) Glucose modulation of ischemic brain injury: review and clinical recommendations. Mayo Clin Proc 71:801–812

    PubMed  CAS  Google Scholar 

  121. Wojnar MM, Fan J, Li YH, Lang CH (1999) Endotoxin-induced changes in IGF-I differ in rats provided enteral vs. parenteral nutrition. Am J Physiol 276:E455–464

    PubMed  CAS  Google Scholar 

  122. Wolf SE, Barrow RE, Herndon DN (1996) Growth hormone and IGF-I therapy in the hypercatabolic patient. Baillieres Clin Endocrinol Metab 10:447–463

    Article  PubMed  CAS  Google Scholar 

  123. Wolfe RR (1997) Substrate utilization/insulin resistance in sepsis/trauma. Baillieres Clin Endocrinol Metab 11:645–657

    Article  PubMed  CAS  Google Scholar 

  124. Yen PM (2001) Physiological and molecular basis of thyroid hormone action. Physiol Rev 81:1097–1142

    PubMed  CAS  Google Scholar 

  125. Zhao Y, Nichols JE, Valdez R, Mendelson CR, Simpson ER (1996) Tumor necrosis factor-alpha stimulates aromatase gene expression in human adipose stromal cells through use of an activating protein-1 binding site upstream of promoter 1.4. Mol Endocrinol 10:1350–1357

    Article  PubMed  CAS  Google Scholar 

  126. Zindrou D, Taylor KM, Bagger JP (2001) Admission plasma glucose: an independent risk factor in nondiabetic women after coronary artery bypass grafting. Diabetes Care 24:1634–1639

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik und Poliklinik für Innere Medizin I, Universität Regensburg, 93042, Regensburg, Germany

    C. E. Wrede

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  1. T. Brünnler
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Serie: Die Notfall- und Intensivtherapie bei endokrinen und metabolischen Erkrankungen Herausgegeben von J. Schölmerich und Ulrike Woenckhaus (Regensburg)

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Brünnler, T., Wrede, C.E. Endokrine Störungen bei kritisch Kranken. Intensivmed 42, 639–652 (2005). https://doi.org/10.1007/s00390-005-0599-4

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  • DOI: https://doi.org/10.1007/s00390-005-0599-4

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