Skip to main content
Top
Published in: Intensive Care Medicine 11/2003

01-11-2003 | Clinical commentary

Is there a role for dehydroepiandrosterone replacement in the intensive care population?

Author: Ketan K. Dhatariya

Published in: Intensive Care Medicine | Issue 11/2003

Login to get access

Excerpt

Adrenal insufficiency in the intensive care population is becoming recognised as a cause of the increased morbidity and mortality seen in these patients. However, currently there is no consensus as to what constitutes 'adrenal insufficiency' in critically ill patients. Most authors agree that the condition is diagnosed by the lack of an appropriate rise in circulating cortisol after adrenal stimulation with an intravenous bolus of synthetic adrenocorticotrophic hormone (ACTH). However, there remain controversies over what dose of synthetic ACTH to use (1 or 250 µg), and what should be the cut-off point in cortisol levels that definitively diagnoses someone as being hypoadrenal. …
Literature
1.
go back to reference Barquist E, Kirton O (1997) Adrenal insufficiency in the surgical intensive care unit patient. J Trauma 42:27–31PubMed Barquist E, Kirton O (1997) Adrenal insufficiency in the surgical intensive care unit patient. J Trauma 42:27–31PubMed
2.
go back to reference Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871PubMed Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871PubMed
3.
go back to reference Zipser RD, Davenport MW, Martin KL, Tuck ML, Warner NE, Swinney RR, Davis CL, Horton R (1981) Hyperreninemic hypoaldosteronism in the critically ill: a new entity. J Clin Endocrinol Metab 53:867–873 Zipser RD, Davenport MW, Martin KL, Tuck ML, Warner NE, Swinney RR, Davis CL, Horton R (1981) Hyperreninemic hypoaldosteronism in the critically ill: a new entity. J Clin Endocrinol Metab 53:867–873
4.
go back to reference Findling JW, Waters VO, Raff H (1987) The dissociation of renin and aldosterone during critical illness. J Clin Endocrinol Metab 64:592–595 Findling JW, Waters VO, Raff H (1987) The dissociation of renin and aldosterone during critical illness. J Clin Endocrinol Metab 64:592–595
5.
go back to reference Kilger E, Weis F, Briegel J, Frey L, Goetz AE, Nagy A, Schuetz A, Lamm P, Knoll A, Peter K (2003) Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery. Crit Care Med 31:1068–1074PubMed Kilger E, Weis F, Briegel J, Frey L, Goetz AE, Nagy A, Schuetz A, Lamm P, Knoll A, Peter K (2003) Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery. Crit Care Med 31:1068–1074PubMed
6.
go back to reference Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, Hemmer B, Hummel T, Lenhart A, Heyduck M, Stoll C, Peter K (1999) Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 27:723–732PubMed Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, Hemmer B, Hummel T, Lenhart A, Heyduck M, Stoll C, Peter K (1999) Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 27:723–732PubMed
8.
go back to reference Orentreich N, Brind JL, Rizer RL, Vogelman JH (1984) Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab 59:551–555PubMed Orentreich N, Brind JL, Rizer RL, Vogelman JH (1984) Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. J Clin Endocrinol Metab 59:551–555PubMed
10.
go back to reference Dhatariya K, Nair KS (2003) DHEA—Is there a role for replacement? Mayo Clin Proc (in press): Dhatariya K, Nair KS (2003) DHEA—Is there a role for replacement? Mayo Clin Proc (in press):
11.
go back to reference Vermes I, Beishuizen A, Hampsink RM, Haanen C (1995) Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone. J Clin Endocrinol Metab 80:1238–1242PubMed Vermes I, Beishuizen A, Hampsink RM, Haanen C (1995) Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone. J Clin Endocrinol Metab 80:1238–1242PubMed
12.
go back to reference Schroeder S, Wichers M, Klingmuller D, Hofer M, Lehmann LE, von Spiegel T, Hering R, Putensen C, Hoeft A, Stuber F (2001) The hypothalamic-pituitary-adrenal axis of patients with severe sepsis: altered response to corticotropin-releasing hormone. Crit Care Med 29:310–316PubMed Schroeder S, Wichers M, Klingmuller D, Hofer M, Lehmann LE, von Spiegel T, Hering R, Putensen C, Hoeft A, Stuber F (2001) The hypothalamic-pituitary-adrenal axis of patients with severe sepsis: altered response to corticotropin-releasing hormone. Crit Care Med 29:310–316PubMed
13.
go back to reference Annane D (2001) Corticosteroids for septic shock. Crit Care Med 29:S117–120PubMed Annane D (2001) Corticosteroids for septic shock. Crit Care Med 29:S117–120PubMed
14.
go back to reference Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M, Engelmann E, Höffken G (2003) Adrenocortical hormones in survivors and nonsurvivors of severe sepsis: diverse time course of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med 31:1382–1388PubMed Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M, Engelmann E, Höffken G (2003) Adrenocortical hormones in survivors and nonsurvivors of severe sepsis: diverse time course of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med 31:1382–1388PubMed
15.
go back to reference Beishuizen A, Thijs LG, Vermes I (2002) Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve? Crit Care 6:434–438CrossRefPubMed Beishuizen A, Thijs LG, Vermes I (2002) Decreased levels of dehydroepiandrosterone sulphate in severe critical illness: a sign of exhausted adrenal reserve? Crit Care 6:434–438CrossRefPubMed
16.
go back to reference Delpedro AD, Barjavel MJ, Mamdouh Z, Bakouche O (1998) Activation of human monocytes by LPS and DHEA. J Interferon Cytokine Res 18:125–135PubMed Delpedro AD, Barjavel MJ, Mamdouh Z, Bakouche O (1998) Activation of human monocytes by LPS and DHEA. J Interferon Cytokine Res 18:125–135PubMed
17.
go back to reference Blauer KL, Poth M, Rogers WM, Bernton EW (1991) Dehydroepiandrosterone antagonizes the suppressive effects of dexamethasone on lymphocyte proliferation. Endocrinology 129:3174–3179PubMed Blauer KL, Poth M, Rogers WM, Bernton EW (1991) Dehydroepiandrosterone antagonizes the suppressive effects of dexamethasone on lymphocyte proliferation. Endocrinology 129:3174–3179PubMed
18.
go back to reference Meikle AW, Dorchuck RW, Araneo BA, Stringham JD, Evans TG, Spruance SL, Daynes RA (1992) The presence of a dehydroepiandrosterone-specific receptor binding complex in murine T cells. J Steroid Biochem Mol Biol 42:293–304PubMed Meikle AW, Dorchuck RW, Araneo BA, Stringham JD, Evans TG, Spruance SL, Daynes RA (1992) The presence of a dehydroepiandrosterone-specific receptor binding complex in murine T cells. J Steroid Biochem Mol Biol 42:293–304PubMed
19.
go back to reference Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendorfer A, Pape HC (2001) Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med 29:380–384PubMed Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendorfer A, Pape HC (2001) Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med 29:380–384PubMed
20.
go back to reference Suzuki T, Suzuki N, Daynes RA, Engleman EG (1991) Dehydroepiandrosterone enhances IL2 production and cytotoxic effector function of human T cells. Clin Immunol Immunopathol 61:202–211PubMed Suzuki T, Suzuki N, Daynes RA, Engleman EG (1991) Dehydroepiandrosterone enhances IL2 production and cytotoxic effector function of human T cells. Clin Immunol Immunopathol 61:202–211PubMed
21.
go back to reference Casson PR, Andersen RN, Herrod HG, Stentz FB, Straughn AB, Abraham GE, Buster JE (1993) Oral dehydroepiandrosterone in physiologic doses modulates immune function in postmenopausal women. Am J Obstet Gynecol 169:1536–1539PubMed Casson PR, Andersen RN, Herrod HG, Stentz FB, Straughn AB, Abraham GE, Buster JE (1993) Oral dehydroepiandrosterone in physiologic doses modulates immune function in postmenopausal women. Am J Obstet Gynecol 169:1536–1539PubMed
22.
go back to reference Morales AJ, Nolan JJ, Nelson JC, Yen SS (1994) Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 78:1360–1367PubMed Morales AJ, Nolan JJ, Nelson JC, Yen SS (1994) Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab 78:1360–1367PubMed
23.
go back to reference Montori VM, Bistrian BR, McMahon MM (2002) Hyperglycemia in Acutely Ill Patients. JAMA 288:2167–2169CrossRefPubMed Montori VM, Bistrian BR, McMahon MM (2002) Hyperglycemia in Acutely Ill Patients. JAMA 288:2167–2169CrossRefPubMed
24.
go back to reference Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Bouillon R, Lauwers P (2001) Intensive insulin therapy in the surgical intensive care unit. N Engl J Med 345:1359–1367PubMed Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Bouillon R, Lauwers P (2001) Intensive insulin therapy in the surgical intensive care unit. N Engl J Med 345:1359–1367PubMed
25.
go back to reference Van den Berghe G, Wouters P, Weekers F, Mohan S, Baxter RC, Veldhuis JD, Bowers CY, Bouillon R (1999) 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 84:1311–1323 Van den Berghe G, Wouters P, Weekers F, Mohan S, Baxter RC, Veldhuis JD, Bowers CY, Bouillon R (1999) 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 84:1311–1323
26.
go back to reference Shepherd A, Cleary MP (1984) Metabolic alterations after dehydroepiandrosterone treatment in Zucker rats. Am J Physiol Endocrinol Metab 246:E123–128 Shepherd A, Cleary MP (1984) Metabolic alterations after dehydroepiandrosterone treatment in Zucker rats. Am J Physiol Endocrinol Metab 246:E123–128
27.
go back to reference Kajita K, Ishizuka T, Miura A, Ishizawa M, Kanoh Y, Yasuda K (2000) The role of atypical and conventional PKC in dehydroepiandrosterone-induced glucose uptake and dexamethasone-induced insulin resistance. Biochem Biophys Res Commun 277:361–367CrossRefPubMed Kajita K, Ishizuka T, Miura A, Ishizawa M, Kanoh Y, Yasuda K (2000) The role of atypical and conventional PKC in dehydroepiandrosterone-induced glucose uptake and dexamethasone-induced insulin resistance. Biochem Biophys Res Commun 277:361–367CrossRefPubMed
28.
go back to reference Herranz L, Megia A, Grande C, Gonzalez-Gancedo P, Pallardo F (1995) Dehydroepiandrosterone sulphate, body fat distribution and insulin in obese men. Int J Obes Relat Metab Disord 19:57–60PubMed Herranz L, Megia A, Grande C, Gonzalez-Gancedo P, Pallardo F (1995) Dehydroepiandrosterone sulphate, body fat distribution and insulin in obese men. Int J Obes Relat Metab Disord 19:57–60PubMed
Metadata
Title
Is there a role for dehydroepiandrosterone replacement in the intensive care population?
Author
Ketan K. Dhatariya
Publication date
01-11-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1981-y

Other articles of this Issue 11/2003

Intensive Care Medicine 11/2003 Go to the issue