Van den Berghe G, de Zegher F
Department of Intensive Care Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Crit Care Med. 1996 Sep;24(9):1580-90. doi: 10.1097/00003246-199609000-00024.
To summarize the available data on anterior pituitary function in critical illness and to focus on the endocrine effects of dopamine infusion. The analogy with anterior pituitary function in the elderly is highlighted, and the potential importance of these observations for recovery from critical illness is discussed.
Computerized search of published research and reference list review.
Review of 178 citations. Included are seven original studies on the effect of dopamine on pituitary function in adult and pediatric critical illness performed by the authors.
Studies on the endocrinology of illness, chronic stress, aging, and dopamine, or on the clinical importance of endocrine changes.
The different pituitary axes are important determinants of normal anabolism and immune function. Continuously increased serum cortisol concentrations, insulin resistance, blunted prolactin release, and attenuated pulsatility of growth hormone and luteinizing hormone secretory patterns, as well as multiple anomalies in the thyroid axis, characterize the endocrine profile of prolonged critical illness. Dopamine, a natural catecholamine with hypophysiotropic properties, which has been used for more than two decades as an inotropic and vasoactive drug in intensive care, suppresses the circulating concentrations of all anterior pituitary-dependent hormones, except for cortisol. Available evidence suggests that the major effect of dopamine administration on the endocrine system is unlikely to be beneficial for the threatened metabolic and immunologic homeostasis of the severely ill patient. This pattern of hypopituitarism induced by chronic, severe illness and exogenous dopamine administration is reminiscent of the hormonal profiles obtained in experimental models of chronic stress, suggesting that endogenous dopamine may play a role in the endocrine and metabolic response to critical illness.
The dopamine-induced or aggravated pituitary dysfunction in critical illness warrants caution with prolonged infusion of this catecholamine as a so-called supportive agent, particularly in early life. The potential of combined hormonal therapy to improve the metabolic and immune status of the critically ill patient deserves thorough investigation.
总结危重病中垂体前叶功能的现有数据，并着重关注多巴胺输注的内分泌效应。强调与老年人垂体前叶功能的类比，并讨论这些观察结果对危重病恢复的潜在重要性。
对已发表研究进行计算机检索并查阅参考文献列表。
对178篇文献进行综述。纳入了作者进行的7项关于多巴胺对成人和儿童危重病中垂体功能影响的原始研究。
关于疾病、慢性应激、衰老和多巴胺的内分泌学研究，或关于内分泌变化的临床重要性的研究。
不同的垂体轴是正常合成代谢和免疫功能的重要决定因素。血清皮质醇浓度持续升高、胰岛素抵抗、催乳素释放减弱、生长激素和促黄体生成素分泌模式的脉冲性减弱，以及甲状腺轴的多种异常，是延长的危重病内分泌特征。多巴胺是一种具有促垂体作用的天然儿茶酚胺，在重症监护中作为强心剂和血管活性药物使用了二十多年，它能抑制所有垂体前叶依赖性激素的循环浓度，但皮质醇除外。现有证据表明，多巴胺给药对内分泌系统的主要影响不太可能对重症患者受到威胁的代谢和免疫稳态有益。由慢性、重症疾病和外源性多巴胺给药引起的这种垂体功能减退模式让人想起在慢性应激实验模型中获得的激素谱，表明内源性多巴胺可能在对危重病的内分泌和代谢反应中起作用。
危重病中多巴胺诱导或加重的垂体功能障碍，警示在长时间输注这种儿茶酚胺作为所谓的支持剂时要谨慎，尤其是在生命早期。联合激素疗法改善重症患者代谢和免疫状态的潜力值得深入研究。
