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Reduced cortisol metabolism during critical illness
Eva Boonen1, Hilke Vervenne, Philippe Meersseman
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
The New England Journal of Medicine
|March 20, 2013
Summary
Critical illness causes higher cortisol levels due to reduced cortisol metabolism and breakdown, leading to suppressed corticotropin. This study investigated cortisol metabolism in critically ill patients versus controls.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Metabolism
Background:
- Critical illness often presents with hypercortisolemia, typically linked to hypothalamic-pituitary-adrenal axis activation.
- However, critically ill patients sometimes exhibit low corticotropin levels, suggesting altered cortisol metabolism.
Purpose of the Study:
- To investigate the role of cortisol metabolism in critical illness.
- To compare cortisol metabolism in intensive care unit (ICU) patients with matched controls.
Main Methods:
- Assessed cortisol metabolism in 158 ICU patients and 64 controls.
- Measured hormone levels, plasma clearance, urinary metabolites, and enzyme activity in liver and adipose tissue.
Main Results:
- ICU patients had higher total and free cortisol, but lower corticotropin levels than controls.
- Cortisol production was 83% higher, and clearance was reduced by over 50% in patients.
- Reduced cortisol metabolism in liver and kidney contributed to a 3.5-fold increase in plasma cortisol.
Conclusions:
- Reduced cortisol breakdown, due to suppressed cortisol-metabolizing enzymes, causes hypercortisolemia and corticotropin suppression in critical illness.
- The clinical implications for critically ill patients require further investigation.
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