Langouche Lies, Van den Berghe Greet
Laboratory and Department of Intensive Care Medicine, University of Leuven, Leuven, Belgium.
Laboratory and Department of Intensive Care Medicine, University of Leuven, Leuven, Belgium.
Handb Clin Neurol. 2014;124:115-26. doi: 10.1016/B978-0-444-59602-4.00008-3.
Independent of the underlying condition, critical illness is characterized by a uniform dysregulation of the hypothalamic-pituitary-peripheral axes. In most axes a clear biphasic pattern can be distinguished. The acute phase of critical illness is characterized by low peripheral effector hormone levels such as T3, IGF-1 and testosterone, despite an actively secreting pituitary. The adrenal axis with high cortisol levels in the presence of low ACTH levels is a noteworthy exception. In the prolonged phase of critical illness, low peripheral effector hormone levels coincide with a uniform suppression of the neuroendocrine axes, predominantly of hypothalamic origin. The severity of the alterations in the different neuroendocrine axes is associated with a high risk of morbidity and mortality, but it remains unknown whether the observed changes are cause or consequence of adverse outcome. Several studies have identified therapeutic potential of hypothalamic releasing factors, but clinical outcome remains to be investigated with sufficiently powered randomized controlled trials.
无论潜在病因如何，危重病的特征是下丘脑 - 垂体 - 外周轴出现一致的调节异常。在大多数轴中，可以区分出明显的双相模式。危重病急性期的特征是外周效应激素水平较低，如T3、胰岛素样生长因子 -1（IGF -1）和睾酮，尽管垂体分泌活跃。促肾上腺皮质激素水平低但皮质醇水平高的肾上腺轴是一个值得注意的例外。在危重病的延长阶段，外周效应激素水平低与神经内分泌轴的一致抑制同时出现，主要起源于下丘脑。不同神经内分泌轴改变的严重程度与高发病率和死亡率风险相关，但观察到的变化是不良结局的原因还是后果仍不清楚。多项研究已确定下丘脑释放因子的治疗潜力，但临床结局仍有待通过足够有力的随机对照试验进行研究。
