Activation of pituitary axis according to underlying critical illness and its effect on outcome

Anna Teresa Mazzeo, Federica Guaraldi, Claudia Filippini, Rachele Tesio, Fabio Settanni, Manuela Lucchiari, Giulio Mengozzi, Silvia Grottoli, Ezio Ghigo, Luciana Mascia

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Critical illness is a life threatening condition inducing a severe acute physical stress. The aim of the study was to investigate the activation of pituitary axis early after ICU admission in patients with critical illnesses of different etiology and its association with outcome. Materials and methods: Patients admitted for acute respiratory distress syndrome (ARDS), severe traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and neurocritically ill patients at the moment of brain death (BD) diagnosis were included in the present post-hoc analysis. On day 1, 2–3 and 4–5 after admission the following pituitary axes were assessed: hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, somatotroph, prolactin and copeptin. ICU mortality was used as outcome measure. Results: One hundred-thirteen critical ill patients were studied. Thyroid axis suppression and activation of copeptin axis were the most frequent pituitary hormone alterations, present in almost 60% of patients. Activation of the hypothalamic pituitary adrenal axis was a predictor of ICU mortality independently from the underlying critical illness [OR 3.952 (C.I.95% 1.129–13.838)]. Conclusions: Pituitary axis function is frequently altered early after ICU admission, the magnitude of hormonal response being different according to the underlying critical illness. The activation of the hypothalamic pituitary adrenal axis was a strong predictor of ICU mortality.

Original languageEnglish
Pages (from-to)22-29
Number of pages8
JournalJournal of Critical Care
Volume54
DOIs
Publication statusPublished - Dec 2019

Keywords

  • Acute respiratory distress syndrome
  • Brain death
  • Intensive care
  • Neuroendocrine dysfunction
  • Subarachnoid hemorrhage
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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