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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad cr&#237;tica induce cambios extensos y complejos que involucran a los sistemas simp&#225;tico-adrenal&#44; al eje hipot&#225;lamo-hipofisario y a las gl&#225;ndulas tiroidea&#44; adrenal y gonadal&#46; En esta revisi&#243;n sistem&#225;tica&#44; se evaluar&#225;n los resultados que diversos estudios han ofrecido sobre el perfil hormonal en pacientes cr&#237;ticos&#44; su papel pron&#243;stico&#44; y las influencias que el momento evolutivo y determinadas intervenciones terap&#233;uticas &#40;sedaci&#243;n&#44; analgesia&#44; catecolaminas ex&#243;genas&#41; ejercen sobre este patr&#243;n</p> <span class="elsevierStyleSectionTitle">Fuente de datos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">B&#250;squeda en base de datos MEDLINE desde 1966 hasta 1999&#46; Se emple&#243; metodolog&#237;a booleana usando los t&#233;rminos hormonas hipofisarias &#40;pituitary hormones&#41;&#44; enfermedad cr&#237;tica &#40;critical illness&#41;&#44; traumatismo &#40;trauma&#41;&#44; y traumatismo craneoencef&#225;lico &#40;head injury&#41;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron por su relevancia 85 estudios</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No se ha establecido un patr&#243;n hormonal caracter&#237;stico en la enfermedad cr&#237;tica&#44; refiriendo patrones no ya faltos de homogeneidad sino absolutamente discrepantes&#46; Ello es explicable por la diversidad de pacientes&#44; m&#233;todos de medida y tipos de lesi&#243;n estudiados&#46; No obstante&#44; parece existir una respuesta distinta seg&#250;n la lesi&#243;n sea aguda o cr&#243;nica&#44; discuti&#233;ndose si las alteraciones encontradas son una respuesta proporcionada y adecuada al estr&#233;s agudo&#46; En funci&#243;n de esta hip&#243;tesis&#44; la suplementaci&#243;n hormonal&#44; el efecto de las hormonas hipofisarias sobre la mortalidad y la modificaci&#243;n de factores terap&#233;uticos que las influyen&#44; podr&#237;an resultar discutibles</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The Critical illness causes complex and wide changes in sympathetic nervous and endocrine systems&#46; These variations have not been completely clarified&#46; In this review&#44; a great variety of studies about the pituitary hormonal pattern in trauma patients will be evaluated&#46; Also&#44; the influence of these hormones on outcome and their modification by the chronology of lesion and therapeutic maneuvers are considered</p> <span class="elsevierStyleSectionTitle">Source of data</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Appropriated studies were retrieved in MEDLINE database from 1966&#46; Boolean strategy was applied using MESH terms as &#8220;pituitary hormones&#8221;&#44; &#8220;trauma&#8221;&#44; &#8220;critical illness&#8221; and &#8220;head injury&#8221;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">85 studies were selected due to their relevance</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">It is not possible to establish a characteristic hormonal pattern in Critical illness&#44; because the results of these works are not only heterogeneous but also indeed discrepant&#46; It is due to differences in design&#44; sample&#44; moment of study&#44; methods of measurement&#44; and type of Critical illness&#46; Notwithstanding&#44; a distinct response seems to be related with chronological aspects of the illness&#46; It is possible that these alterations make up a proportional and proper response to acute stress&#46; In agreement with this hypothesis&#44; the supplementation of pituitary hormones&#44; their relation with morbidity and mortality&#44; and variation in therapeutic agents would be questionable</p>"
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Vol. 24. Núm. 7.
Páginas 307-315 (octubre 2000)
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Vol. 24. Núm. 7.
Páginas 307-315 (octubre 2000)
Acceso a texto completo
Patrón hormonal hipofisario anterior y tiroideo en el paciente crítico
Anterior pituitary and thiroid hormonal pattern in the critically ill patients
Visitas
11286
V. Gómez Tello1
Servicio de Medicina Intensiva. Clínica Moncloa
A. García De Lorenzo Y Mateos*, J.M. Añón Elizalde**, J. López Martínez***
* Hospital Universitario La Paz. Madrid
** Hospital Virgen de la Luz. Cuenca
*** Hospital Severo Ochoa. Leganés. Madrid
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Estadísticas
Objetivo

La enfermedad crítica induce cambios extensos y complejos que involucran a los sistemas simpático-adrenal, al eje hipotálamo-hipofisario y a las glándulas tiroidea, adrenal y gonadal. En esta revisión sistemática, se evaluarán los resultados que diversos estudios han ofrecido sobre el perfil hormonal en pacientes críticos, su papel pronóstico, y las influencias que el momento evolutivo y determinadas intervenciones terapéuticas (sedación, analgesia, catecolaminas exógenas) ejercen sobre este patrón

Fuente de datos

Búsqueda en base de datos MEDLINE desde 1966 hasta 1999. Se empleó metodología booleana usando los términos hormonas hipofisarias (pituitary hormones), enfermedad crítica (critical illness), traumatismo (trauma), y traumatismo craneoencefálico (head injury)

Resultados

Se seleccionaron por su relevancia 85 estudios

Conclusiones

No se ha establecido un patrón hormonal característico en la enfermedad crítica, refiriendo patrones no ya faltos de homogeneidad sino absolutamente discrepantes. Ello es explicable por la diversidad de pacientes, métodos de medida y tipos de lesión estudiados. No obstante, parece existir una respuesta distinta según la lesión sea aguda o crónica, discutiéndose si las alteraciones encontradas son una respuesta proporcionada y adecuada al estrés agudo. En función de esta hipótesis, la suplementación hormonal, el efecto de las hormonas hipofisarias sobre la mortalidad y la modificación de factores terapéuticos que las influyen, podrían resultar discutibles

Palabras clave:
hormonas hipofisarias
enfermedad crítica
traumatismo
traumatismo craneoencefálico
Objective

The Critical illness causes complex and wide changes in sympathetic nervous and endocrine systems. These variations have not been completely clarified. In this review, a great variety of studies about the pituitary hormonal pattern in trauma patients will be evaluated. Also, the influence of these hormones on outcome and their modification by the chronology of lesion and therapeutic maneuvers are considered

Source of data

Appropriated studies were retrieved in MEDLINE database from 1966. Boolean strategy was applied using MESH terms as “pituitary hormones”, “trauma”, “critical illness” and “head injury”

Results

85 studies were selected due to their relevance

Conclusions

It is not possible to establish a characteristic hormonal pattern in Critical illness, because the results of these works are not only heterogeneous but also indeed discrepant. It is due to differences in design, sample, moment of study, methods of measurement, and type of Critical illness. Notwithstanding, a distinct response seems to be related with chronological aspects of the illness. It is possible that these alterations make up a proportional and proper response to acute stress. In agreement with this hypothesis, the supplementation of pituitary hormones, their relation with morbidity and mortality, and variation in therapeutic agents would be questionable

Key words:
Pituitary hormones
critical illness
trauma
head injury
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Copyright © 2000. Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L.
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