Year: 2010
Type: dissertation
Abstract: The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the modulation of stress and inflammation in critically ill patients.HPA-axis dysfunction may negatively affect outcome.The objective of this study was to evaluate HPA function in different critically ill patient categories and to determine if HPA dysfunction is present.A total of 237 critically ill patients were enrolled in the study.Sixty-six patients with severe aortic stenosis received either etomidate or propofol to induce anaesthesia, and 125 patients had severe sepsis or septic shock.Thirty patients had acute aneurysmal subarachnoid haemorrhage (aSAH), and 16 patients who underwent elective intracranial aneurysm surgery served as their control.The free and/or total serum cortisol response was evaluated in all patient categories, and the insulin-like growth factor-I (IGF-I) concentrations were measured in patients with aSAH.In patients with severe aortic stenosis etomidate transiently depressed cortisol synthesis and thus shortly affected the inflammatory response.However, etomidate did not cause as mutch hypotension than propofol.In patients with severe sepsis, the free and total serum cortisol concentrations correlated well.The severity of aSAH did not affect the free or total serum cortisol concentrations.The adrenocorticotropic-cortisol profile of some patients indicated secondary adrenal insufficiency (AI) in the acute phase of aSAH.Patients with aSAH had low IGF-I concentrations in the acute phase of the disease.Calculating free serum cortisol does not provide any advantages over measuring total serum cortisol in patients with severe sepsis, septic shock.Free serum cortisol was not helpful for predicting mortality in patients with severe sepsis or septic shock.The severity of aSAH does not affect free or total serum cortisol concentrations.In the acute phase, some patients may have secondary AI.Serum IGF-I may contribute to increased morbidity in patients with aSAH.Etomidate transiently decreases serum cortisol concentration.Propofol is twice as likely as etomidate to evoke hypotension
Author: Stepani Bendel
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Kuopion Yliopistollinen Sairaala
OpenAlex ID: W3096460251