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The endocrine response to critical illness

C A Rolih¹, K P Ober

¹Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina.

The Medical Clinics of North America

|January 1, 1995

Summary

Critical illness triggers complex endocrine changes, including stress hormone elevations, impacting metabolism and fluid balance. Clinicians must differentiate appropriate responses from independent disorders for effective patient management.

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Area of Science:

Endocrinology
Critical Care Medicine
Physiology

Background:

The endocrine system's response to stress is intricate and multifaceted.
Critical illness often leads to significant hormonal fluctuations affecting metabolism and fluid balance.

Purpose of the Study:

To explore the complex endocrine responses to critical illness.
To differentiate appropriate homeostatic hormonal changes from independent metabolic disorders.

Main Methods:

Review of hormonal changes in critically ill patients.
Analysis of "classic" stress hormones (epinephrine, cortisol), pituitary hormones (corticotropin), growth hormone (GH), glucagon, vasopressin, renin, aldosterone, and thyroid hormones.
Examination of the reproductive axis response.

Main Results:

Elevated epinephrine, cortisol, corticotropin, GH, and glucagon contribute to hyperglycemia and hypercatabolism.
Volume depletion can stimulate vasopressin, renin, and aldosterone, potentially causing fluid retention and hyponatremia.
Euthyroid sick syndrome and hypogonadotropic hypogonadism are common findings in critical illness.

Conclusions:

Interpreting hormonal changes in critical illness requires careful clinical correlation.
Distinguishing adaptive endocrine responses from pathological conditions is crucial for patient care.
A holistic patient approach is preferred over indiscriminate hormone testing to avoid misinterpretation and therapeutic errors.