The Endocrine Response to Critical Illness

  • Katherine Ratzan Peeler
  • Michael S. D. Agus


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.


Adrenal Thyroid Growth hormone Androgen Critical illness-related corticosteroid insufficiency Hypothyroxinemia of non-thyroidal illness Endocrinopathies in critical illness 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Katherine Ratzan Peeler
    • 1
    • 2
  • Michael S. D. Agus
    • 3
    • 4
    • 5
  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Division of Medicine Critical Care, Department of Medicine, Boston Children’s HospitalBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Division of Medicine Critical Care, Department of Medicine, Boston Children’s HospitalBostonUSA
  5. 5.Division of Endocrinology, Department of Medicine, Boston Children’s HospitalBostonUSA

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