Evidence of Altered Cortisol Metabolism in Critically Ill Patients: a Prospective Study

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2007 Jun 15

PMID 17558491

Citations 17

Authors

Bala Venkatesh

Jeremy Cohen

Ingrid Hickman

Janelle Nisbet

Peter Thomas

Gregory Ward

Jonathan Hall

John Prins

Affiliations

Soon will be listed here.

Abstract

Context: Changes in cortisol metabolism due to altered activity of the enzyme 11beta-hydroxysteroid dehydrogenase (11beta-HSD) have been implicated in the pathogenesis of hypertension, obesity and the metabolic syndrome. No published data exist on the activity of this enzyme in critical illness.

Objective: To investigate cortisol metabolism in critically ill patients utilising plasma cortisol: cortisone ratio as an index of 11beta-HSD activity.

Setting: Tertiary level intensive care unit.

Patients: Three cohorts of critically ill patients: sepsis (n = 13); multitrauma (n = 20); and burns (n = 19).

Main Outcome Measures: Serial plasma cortisol: cortisone ratios.

Measurements And Main Results: Plasma total cortisol cortisone ratios were determined serially after admission to the intensive care unit. As compared with controls, the plasma cortisol:cortisone ratio was significantly elevated in the sepsis and trauma cohorts on day 1 (22 +/- 9, p = 0.01, and 23 +/- 19, p = 0.0003, respectively) and remained elevated over the study period. Such a relationship was not demonstrable in burns. The ratio was significantly correlated with APACHE II (r = 0.77, p = 0.0008) and Simplified Acute Physiology Score (r = 0.7, p = 0.003) only on day 7 and only in the burns cohort. There were no significant correlations observed between total plasma cortisol or cortisone and sickness severity in the sepsis and trauma cohorts.

Conclusions: In critically ill patients, there is evidence of altered cortisol metabolism due to an increase in 11beta-HSD activity as demonstrated by an elevation of plasma cortisol: cortisone ratios. Further studies with larger sample sizes specifically designed to examine altered tissue 11beta-HSD activity and its clinical significance and correlation with outcome are warranted.

Citing Articles

Glucocorticoids with or without fludrocortisone in septic shock: a narrative review from a biochemical and molecular perspective.

Nethathe G, Lipman J, Anderson R, Fuller P, Feldman C Br J Anaesth. 2023; 132(1):53-65.

PMID: 38030548 PMC: 10797514. DOI: 10.1016/j.bja.2023.10.034.

Impaired alveolar macrophage 11β-hydroxysteroid dehydrogenase type 1 reductase activity contributes to increased pulmonary inflammation and mortality in sepsis-related ARDS.

Mahida R, Lax S, Bassford C, Scott A, Parekh D, Hardy R Front Immunol. 2023; 14:1159831.

PMID: 37180160 PMC: 10172463. DOI: 10.3389/fimmu.2023.1159831.

Down-Regulation of the Mineralocorticoid Receptor (MR) and Up-Regulation of Hydroxysteroid 11-Beta Dehydrogenase Type 2 (HSD11B2) Isoenzyme in Critically Ill Patients.

Vassiliou A, Vassiliadi D, Keskinidou C, Jahaj E, Botoula E, Tsagarakis S Clin Med Res. 2023; 21(1):6-13.

PMID: 37130784 PMC: 10153682. DOI: 10.3121/cmr.2023.1743.

Clinical and Technical Aspects in Free Cortisol Measurement.

Choi M Endocrinol Metab (Seoul). 2022; 37(4):599-607.

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CIRMI-a new term for a concept worthy of further exploration: a narrative review.

Nethathe G, Lipman J, Anderson R, Feldman C Ann Transl Med. 2022; 10(11):646.

PMID: 35813323 PMC: 9263790. DOI: 10.21037/atm-21-5572.

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