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Anterior pituitary function in critical illness.
Arno Téblick1, Lies Langouche1, Greet Van den Berghe1
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Endocrine Connections
|July 25, 2019
Summary
Critical illness alters hormonal axes. While acute changes aid survival, prolonged illness shows suppressed axes, potentially harming recovery. Hypothalamic hormone treatments show promise.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Neuroendocrinology
Background:
- Critical illness profoundly impacts hypothalamic-pituitary-peripheral hormonal axes.
- Hormonal changes follow a biphasic pattern, initially promoting catabolism for energy, then potentially hindering recovery in prolonged critical illness.
Purpose of the Study:
- To analyze the biphasic hormonal axis alterations in critical illness.
- To evaluate the impact of prolonged critical illness on neuroendocrine function.
- To review therapeutic strategies for hormonal dysregulation in critical illness.
Main Methods:
- Review of animal and human studies on hormonal axes during critical illness.
- Analysis of hormonal level patterns in acute and prolonged critical illness phases.
- Evaluation of studies on hormone substitution and hypothalamic hormone treatments.
Main Results:
- Acute critical illness induces catabolic hormonal changes for energy provision.
- Prolonged critical illness is characterized by uniform suppression of hormonal axes.
- Peripheral hormone substitution and anabolic resistance strategies show limited benefits.
- Hypothalamic hormone treatments demonstrate promising results in preliminary research.
Conclusions:
- Endocrine changes in prolonged critical illness may be detrimental to recovery.
- Targeting hypothalamic hormones may offer a more effective therapeutic strategy.
- Further randomized controlled trials are necessary to validate findings on hypothalamic hormone treatments.
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