Hormone in der Intensivmedizin

Zusammenfassung

Veränderungen der hormonellen Regulation bei kritisch Kranken sind bereits seit vielen Jahren bekannt. Größere Aufmerksamkeit erlangten in den letzten Jahren zwei Themen, bei denen jeweils ein Überlebensvorteil durch eine einzelne Intervention publiziert wurde: die intensive Blutzuckereinstellung bei chirurgischen Intensivpatienten und die niedrigdosierte Hydrocortison-Therapie bei Sepsis. Diese Erkenntnisse fanden rasch Einzug in Leitlinien, mittlerweile sind jedoch in beiden Feldern große Multizenterstudien durchgeführt worden, welche die initialen Resultate nicht im gleichen Maße bestätigen konnten. Diese Übersicht stellt diese und weitere Störungen der endokrinen Regulation bei kritisch kranken Patienten dar.

Abstract

Disturbances of the hormonal regulation of critically ill patients are known since many years. In the last years, two topics received a lot of attention since a single intervention led to a mortality benefit: the intensive blood glucose control in surgical intensive care patients and the low dose hydrocortisone therapy in sepsis. These results were quickly incorporated in guidelines. However, large multi-center studies failed to support the initial results in several points. This review discusses these and other disturbances of endocrine regulation of critically ill patients.

Schlüsselwörter

Hormonregulation - Intensivmedizin

Keywords

endocrine regulation - critical care

Literatur

• 1 Annane D, Sebille V, Charpentier C. et al . Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock.  J Am Med Assoc. 2002;  288 862-871
• 2 Bello G, Pennisi M A, Montini L, Silva S, Maviglia R, Cavallaro F, Bianchi A, De Marinis L, Antonelli M. Nonthyroidal illness syndrome and prolonged mechanical ventilation in patients admitted to the ICU.  Chest. 2009;  135 1448-1454
• 3 Branski L K, Herndon D N, Barrow R E, Kulp G A, Klein G L, Suman O E, Przkora R, Meyer 3rd W, Huang T, Lee J O, Chinkes D L, Mlcak R P, Jeschke M G. Randomized controlled trial to determine the efficacy of long-term growth hormone treatment in severely burned children.  Ann Surg. 2009, epub ahead of print; 
• 4 Brunkhorst F M, Engel C, Bloos F. et al . Intensive insulin therapy and pentastarch resuscitation in severe sepsis.  N Engl J Med. 2008;  358 125-139
• 5 Capes S E, Hunt D, Malmberg K, Gerstein H C. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview.  Lancet. 2000;  355 773-778
• 6 Chrousos G P, Gold P W. The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis.  J Am Med Assoc. 1992;  267 1244-1252
• 7 Cronin L, Cook D J, Carlet J, Heyland D K, King D, Lansang M A, Fisher  Jr C J. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature.  Crit Care Med. 1995;  23 1430-1439
• 8 Dellinger R P, Levy M M, Carlet J M. et al . Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.  Intensive Care Med. 2008;  34 17-60
• 9 Finfer S, Chittock D R, Su S Y. et al . Intensive versus conventional glucose control in critically ill patients.  N Engl J Med. 2009;  360 1283-1297
• 10 Fliers E, Alkemade A, Wiersinga W M. The hypothalamic-pituitary-thyroid axis in critical illness.  Best Pract Res Clin Endocrinol Metab. 2001;  15 453-464
• 11 Fliers E, Guldenaar S E, Wiersinga W M, Swaab D F. Decreased hypothalamic thyrotropin-releasing hormone gene expression in patients with nonthyroidal illness.  J Clin Endocrinol Metab. 1997;  82 4032-4036
• 12 Griesdale D E, de Souza R J, van Dam R M. et al . Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data.  Canad Med Assoc J. 2009;  180 821-827
• 13 Herndon D N, Tompkins R G. Support of the metabolic response to burn injury.  Lancet. 2004;  363 1895-1902
• 14 Ho J T, Al-Musalhi H, Chapman M J, Quach T, Thomas P D, Bagley C J, Lewis J G, Torpy D J. Septic shock and sepsis: a comparison of total and free plasma cortisol levels.  J Clin Endocrinol Metab. 2006;  91 105-114
• 15 Klemperer J D, Klein I, Gomez M, Helm R E, Ojamaa K, Thomas S J, Isom O W, Krieger K. Thyroid hormone treatment after coronary-artery bypass surgery.  N Engl J Med. 1995;  333 1522-1527
• 16 Krinsley J S. Glycemic variability: a strong independent predictor of mortality in critically ill patients.  Crit Care Med. 2008;  36 3008-3013
• 17 Marik P E, Pastores S M, Annane D. et al . Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine.  Crit Care Med. 2008;  36 1937-1949
• 18 Mebis L, Debaveye Y, Ellger B, Derde S, Ververs E J, Langouche L, Darras V M, Fliers E, Visser T J, Van den Berghe G. Changes in the central component of the hypothalamus-pituitary-thyroid axis in a rabbit model of prolonged critical illness.  Crit Care. 2009;  13 R147
• 19 Mizock B A. Alterations in fuel metabolism in critical illness: hyperglycaemia.  Best Pract Res Clin Endocrinol Metab. 2001;  15 533-551
• 20 Mönig H, Arendt T, Meyer M, Kloehn S, Bewig B. Activation of the hypothalamo-pituitary-adrenal axis in response to septic or non-septic diseases – implications for the euthyroid sick syndrome.  Intensive Care Med. 1999;  25 1402-1406
• 21 Pham T N, Klein M B, Gibran N S, Arnoldo B D, Gamelli R L, Silver G M, Jeschke M G, Finnerty C C, Tompkins R G, Herndon D N. Impact of oxandrolone treatment on acute outcomes after severe burn injury.  J Burn Care Res. 2008;  29 902-906
• 22 Plikat K, Langgartner J, Buettner R, Bollheimer L C, Woenckhaus U, Scholmerich J, Wrede C E. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit.  Metabolism. 2007;  56 239-244
• 23 Preiser J C, Devos P, Ruiz-Santana S. et al . A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.  Intensive Care Med. 2009;  35 1738-1748
• 24 Schein R M, Sprung C L, Marcial E, Napolitano L, Chernow B. Plasma cortisol levels in patients with septic shock.  Crit Care Med. 1990;  18 259-263
• 25 Schuetz P, Muller B, Nusbaumer C, Wieland M, Christ-Crain M. Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients.  Eur J Endocrinol. 2009;  160 157-163
• 26 Spratt D I, Cox P, Orav J, Moloney J, Bigos T. Reproductive axis suppression in acute illness is related to disease severity.  J Clin Endocrinol Metab. 1993;  76 1548-1554
• 27 Sprung C L, Annane D, Keh D. et al . Hydrocortisone therapy for patients with septic shock.  N Engl J Med. 2008;  358 111-124
• 28 Takala J, Ruokonen E, Webster N R, Nielsen M S, Zandstra D F, Vundelinckx G, Hinds C J. Increased mortality associated with growth hormone treatment in critically ill adults.  N Engl J Med. 1999;  341 785-792
• 29 Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters P J, Milants I, Van Wijngaerden E, Bobbaers H, Bouillon R. Intensive insulin therapy in the medical ICU.  N Engl J Med. 2006;  354 449-461
• 30 Van den Berghe G, Wilmer A, Milants I, Wouters P J, Bouckaert B, Bruyninckx F, Bouillon R, Schetz M. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm.  Diabetes. 2006;  55 3151-3159
• 31 Van den Berghe G, Wouters P, Weekers F, Mohan S, Baxter R C, Veldhuis J D, Bowers C Y, Bouillon R. Reactivation of pituitary hormone release and metabolic improvement by infusion of growth hormone-releasing peptide and thyrotropin-releasing hormone in patients with protracted critical illness.  J Clin Endocrinol Metab. 1999;  84 1311-1323
• 32 van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R. Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367