Información del artículo
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 datosBúsqueda 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)
ResultadosSe seleccionaron por su relevancia 85 estudios
ConclusionesNo 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 dataAppropriated studies were retrieved in MEDLINE database from 1966. Boolean strategy was applied using MESH terms as “pituitary hormones”, “trauma”, “critical illness” and “head injury”
Results85 studies were selected due to their relevance
ConclusionsIt 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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Bibliografía
[1.]
R. Chioléro, J.P. Revelly, T. Lemarchand-Béraud.
Endocrine Response after Brain Injury.
Yearbook of Intensive Care and Emergency Medicine, pp. 588-596
[2.]
D. Annane, E. Bellisant, P.E. Bollaert, I. Auriant, D. Ghez, J.C. Raphael, et al.
The hypothalamus-pituitary axis in septic shock.
British Journal of Intensive Care, 6 (1996), pp. 260-266
[3.]
E. Mocchegiani, R. Imberti, D. Testasecca, M. Zandri, L. Santarelli, N. Fabris.
Thyroid and thymic endocrine function and survival in severely traumatized patients with or without head injury.
Intensive Care Med, 21 (1995), pp. 334-341
[4.]
A. García de Lorenzo, C. Ortiz.
y Grupo de Trabajo de Metabolismo y Nutrición. Respuesta a la agresión: valoración e implicaciones terapéuticas.
Medicina Intensiva, 21 (1997), pp. 13-28
[5.]
G.H. Van den Berghe.
Acute and prolonged critical illness are two distinct neuroendocrine paradigms.
Vehr K Acad Genesskd Belg, 60 (1998), pp. 487-518
[6.]
L. Wartofsky, K.D. Burman.
Alterations in thyroid function in patients with systemic illness: The “euthiroid sick syndrome”.
Endocr Rev, 3 (1982), pp. 164-217
[7.]
O.M. Edwards, J.D.A. Clark.
Post-traumatic hypopituitarism. Six cases and a review of the literature.
Medicine, 65 (1980), pp. 281-290
[8.]
P.M. Daniel, M.M.L. Prichard, C.S. Treip.
Traumatic Infarction of anterior lobe of pituitary gland.
Lancet, II (1959), pp. 81-84
[9.]
R. Crompton.
Hypothalamic lesions following close head injury.
Brain, 94 (1971), pp. 165-172
[10.]
S.G. Barber.
Hypopituitarism and artificial ventilation.
Acta Endocrinol (Copenh, 90 (1979), pp. 211-216
[11.]
G. Van den Berghe, F. De Zegher, R.C. Baxter, J.D. Veldhuis, P. Wouters, M. Schetz, et al.
Neuroendocrinology of prolonged critical illness: effects of exogenous thyrotropin-releasing hormone and its combination with growth hormone secretagogues.
J Clin Endocrinol Metab, 83 (1998), pp. 309-319
[12.]
D. Rudman, A.S. Fleischer, M.H. Kutner, J.F. Raggio.
Suprahypophyseal hypogonadism and hypothyroidism during prolonged coma after head trauma.
JCE&M, 45 (1977), pp. 747-754
[13.]
H. Matsuura, S. Nakazawa, I. Wakabayashi.
Thyrotropin releasing hormone provocative release of prolactin and thyrotropin in acute head injury.
Neurosurgery, 16 (1985), pp. 791-795
[14.]
D. Wilmore, T. Orcutt, A. Mason, B.A. Pruitt.
Alterations in hypothalamic function following thermal injury.
J Trauma, 15 (1975), pp. 697-703
[15.]
L. Brizio-Molteni, A. Molteni, R. Warpeha.
Prolactin corticotrophin and gonadotropin concentrations following thermal injury in adults.
J Trauma, 24 (1984), pp. 1-7
[16.]
R. Chioléro, T.H. Lemarchand, Y. Schutz, N. Tribolet, J.P. Felber, J. Freeman, et al.
Plasma pituitary hormone levels in severe trauma with or without head injury.
J Trauma, 28 (1988), pp. 1368-1374
[17.]
L.R. King, H.C. Knowles, R.L. Mclaurin, J. Brielmaier, G. Perisutti, V.K. Piziak, et al.
Pituitary hormone response to head injury.
Neurosurgery, 9 (1981), pp. 229-235
[18.]
A. García de Lorenzo, J.M. Añón, J. López Martinez, J. Peláez, M. Sisón, M. Sánchez Castilla.
Neuroendocrinethyroid responses after trauma: does head injury make any difference.
Crit Care Med, 25 (1996), pp. 132
[19.]
A. García de Lorenzo, J. López Martínez, J.M. Añón, M. Sánchez Castilla, D. Díaz Díaz, C. Vaquero.
Anterior pituitary and thyroid response after trauma. Modifying factors.
Intensive Care Med, 23 (1997), pp. 188-235
[20.]
J.E. Blalock.
A molecular basis for bi-directional communication between the immune and neuroendocrine systems.
Physiol Rev, 69 (1989), pp. 1-32
[21.]
R.I. Weiner, W.F. Ganong.
Role of brain monoamines and histamine in regulation of anterior pituitary secretion.
Physiol Rev, 58 (1978), pp. 905-976
[22.]
D. Perrot, A. Bonneton, H. Dechaud, J. Motin, M. Pugeat.
Hypercortisolism in septic shock is not suppressible by dexamethasone infusion.
Crit Care Med, 21 (1993), pp. 396-401
[23.]
G.J. Molijn, J.W. Koper, C.J.C. Van Uffelen, F.H. de Jong, A.O. Brinkmann, H.A. Bruining, et al.
Temperature-induced down regulation of the glucocorticoid receptor in peripheral blood mononuclear leukocytes in patients with sepsis and septic shock.
Clin Endocrinol, 43 (1995), pp. 197-203
[24.]
P. Navarra.
The effects of endotoxin on neuroendocrin axis.
Curr Opinion Endocrinol Diabetes, 2 (1995), pp. 127-133
[25.]
M. Reincke, B. Allolio, G. Würth, W. Winkelmann.
The hypothalamic-pituitary-adrenal axis in critical illnes: response to dexamethasone and corticotropin-releasing hormone.
J Clin Endocrinol Metab, 77 (1993), pp. 151-156
[26.]
I. Vermes, A. Vbeishuizen, R.M. Hampsink, C. Haanen.
Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone.
J Clin Endocrinol Metab, 80 (1995), pp. 1238-1242
[27.]
P.D. Wrigth, I.D.A. Johnston.
The effect of surgical operation on growth hormone levels in plasma.
Surgery, 77 (1975), pp. 479-486
[28.]
E. Rayfield, T.D. George, W.R. Beisel.
Altered growth hormone homeostasis during acute bacterial sepsis in the rhesus monkey.
J Clin Endocrinol Metab, 38 (1974), pp. 746-754
[29.]
M.S. Dahn, D.L. Bouwman, J.R. Kirkpatrick.
The sepsis-glucose intolerance riddle: A hormonal explanation.
Surgery, 86 (1979), pp. 423-428
[30.]
M.S. Dahn, J.R. Kirkpatrick, D.L. Bouwman.
Sepsis, glucoseintolerance and protein malnutrition: A metabolic paradox.
Arch Surg, 115 (1980), pp. 1415-1418
[31.]
M.S. Dahn, L.A. Jacobs, M.P. Lange, S. Smith, R.A. Mitchell.
Endocrine mediators of metabolism associated with injury and sepsis.
JPEN, 10 (1986), pp. 253-257
[32.]
M. Jeevanandan, L. Ramias, R.F. Shamos, W.R. Schiller.
Decreased growth hormone levels in the catabolic phase of severe injury.
Surgery, 111 (1992), pp. 495-502
[33.]
C. Botfield, J. Ross, C.J. Hinds.
The role of IGFs in catabolism.
Baillieres Clin Endocrinol Metab, 11 (1997), pp. 679-697
[34.]
J.K. Manson, D.W. Wilmore.
Positive nitrogen balance with human growth hormone and hypocaloric intravenous feeding.
Surgery, 100 (1986), pp. 188-197
[35.]
S.R. Peterson, N.J. Holaday, M. Jeevanandan.
Enhancement of protein synthesis efficiency in parenterally fed trauma victims by adjuvant recombinant human growth hormone.
J Trauma, 36 (1994), pp. 726-733
[36.]
M. Gottardis, A. Benzer, W. Koller, T.J. Luger, F. Pühringer, J. Hackl.
Improvement of septic syndrome after administration of recombinant human growth hormone (rhGH)?.
J Trauma, 31 (1991), pp. 81-86
[37.]
R. Vara-Thorbeck, J.A. Guerrero, M.E. Ruiz-Requena, J. Capitán, M. Rodríguez, J. Rosell, et al.
Effects of growth hormone in patients receiving total parenteral nutrition following major gastrointestinal surgery.
Hepatogastroenterology, 39 (1992), pp. 270-272
[38.]
Z.M. Jiang, G.Z. He, S.Y. Zhang, X.R. Wang, N.F. Yang, Y. Zhu, et al.
Low-dose Growth hormone and hypocaloric nutrition attenuate the protein-catabolic response after major operation.
Ann Surg, 210 (1989), pp. 513-525
[39.]
K.A. Kudsk, C. Mowatt-Larssen, J. Bukar, T. Fabian, S. Oellerich, D.L. Dent, et al.
Effect of recombinant human Insulin-like growth factor I and early total parenteral nutrition on immune depression following severe head injury.
Arch Surg, 129 (1994), pp. 66-71
[40.]
G. Van den Berghe, F. De Zegher, J.D. Veldhuis, P. Wouters, M. Awouters, W. Verbruggen, et al.
The somatotropic axis in critical illness: effect of continuous growth hormone (GH)-releasing hormone and GH-releasing peptide 2 infusion.
J Clin Endocrinol Metab, 82 (1997), pp. 590-599
[41.]
J. Knox, R. Demling, D. Wilmore, P. Sarraf, A. Santos.
Increased survival after major thermal injury: the effect of growth hormone therapy in adults.
J Trauma, 39 (1995), pp. 526-530
[42.]
T.R. Ziegler, L.S. Young, E. Ferrari-Baliviera, R.H. Demling, D.W. Wilmore.
Use of human growth hormone combined with nutrititional support in a critical care unit.
JPEN, 14 (1990), pp. 574-581
[43.]
J. Takala, E. Ruokonen, N.R. Webster, M.S. Nielsen, D.F. Zandstra, G. Vundelincks, et al.
Increased mortality associated with growth hormone treatment in critically ill adults.
N Engl J Med, 341 (1999), pp. 785-792
[44.]
R. Demling.
Growth hormone therapy in critically ill patients.
N Engl J Med, 341 (1999), pp. 837-839
[45.]
S.A. Desai, D.O. Jacobs.
Role of growth hormone in the septic, trauma and surgical patient.
Growth hormone in ciritcal illness, pp. 119-140
[46.]
R.Y. Flemming, R.L. Rutan, R.E. Jahoor, R.R. Wolfe, D.N. Herndon.
Effect of recombinant human growth hormone on catabolic hormones and free fatty acids following thermal injury.
J Trauma, 32 (1992), pp. 698-702
[47.]
A. Kowal-Vern, M.M. Sharp-Pucci, J.M. Walenga, D.J. Dries, R.L. Gamelli.
Trauma and thermal injury: comparison of hemostatic and cytokine chagnesin the acute phase of injury.
J Trauma, 44 (1998), pp. 325-329
[48.]
A.V. Vogel, G.T. Peake, R.T. Rada.
Pituitary-testicular axis dysfunction in burned med.
J Clin Endocrinol Metab, 60 (1985), pp. 658-665
[49.]
D.I. Spratt, P. Cox, J. Orav, J. Moloney, T. Bigos.
Reproductive axis suppression in acute illness is related to disease severity.
J Clin Endocrinol Metab, 76 (1993), pp. 1548-1554
[50.]
J. Levin, C.V. Lloyd, J. Lobostsky, E.H. Friedrich.
The effect of epinephrine on testosterone production.
Acta Endocrinol (Copenh, 55 (1967), pp. 184-190
[51.]
T.J. Cicero, E.R. Meyer, S.M. Gabriel, R.D. Bell, C.E. Wilcox.
Morphine exerts testosterone-like effects in the hypothalamus of the castrated male rat.
Brain Res, 202 (1980), pp. 151-156
[52.]
P.D. Woolf, R.W. Hamill, J.V. McDonald, L.A. Lee, M. Kelly.
Transient hypogonadotropic hypogonadism caused by critical illness.
J Clin Endocrinol Metab, 60 (1985), pp. 444-450
[53.]
R. Zellweger, M.W. Wichman, A. Ayala, C.M. DeMaso, I.H. Chaudry.
Prolactin: a novel and safe immunomodulating hormone for the treatment of immunodepression following severe hemorrhage.
J Surg Res, 63 (1996), pp. 53-58
[54.]
R. Zellweger, M.W. Wichmann, A. Ayala, I.H. Chaudry.
Metoclopramide: a novel and safe immunomodulating agent for restoring the depressed macrophage immune function after hemorrhage.
J Trauma, 44 (1998), pp. 70-77
[55.]
J.I. Mechanick, H.S. Sacks, R.H. Cobin.
Hypothalamic-pituitary axis dysfunction in critically ill patients with a low free thyroxine index.
J Endocrinol Invest, 20 (1997), pp. 462-470
[56.]
G. Van den Berghe, F. De Zegher.
Anterior pituitary function during critical illness and dopamine treatment.
Crit Care Med, 24 (1996), pp. 1580-1590
[57.]
R.A. Vos, M. De Jong, B.F. Bernard, R. Docter, E.P. Krenning, G. Hennemann.
Impaired thyroxine and 3,5,3’-triiodothyronine handling by rat hepatocytes in the presence of serum of serum of patients with nonthyroidal illness.
J Clin Endocrinol Metab, 80 (1995), pp. 2.364-2.370
[58.]
M. Wolf, N. Hansen, H. Greten.
Interleukin 1 beta, tumor necrosis factor-alpha and interlukin 6 decreasee nuclear thyroid hormone receptor capacity in a liver cell line.
Eur J Endocrinol, 131 (1994), pp. 307-312
[59.]
H. Mönig, T. Arendt, M. Meyer, B. Kloehn Bewig.
Activation of the hypothalamolppituitary-adrenal axis in response to septic or non-septic diseases-implications for the euthyroid sick syndrome.
Intensive Care Med, 25 (1999), pp. 1.402-1.406
[60.]
H. Vierhapper, A. Laggner, W. Waldhäusl, B. Grubeck-Loeebenstein, G. Kleinberger.
Impaired secretion of TSH in critically ill patients with `low T4-syndrome´.
Acta Endocrinol, 101 (1982), pp. 542-549
[61.]
J. Faber, C. Kierkegaard, B. Rasussen, H. Westh, M. Busch-Sorensen, I.W. Jensen.
Pituitary-Thyroid axis in critical illness.
J Clin Endocrinol Metab, 65 (1987), pp. 315-320
[62.]
G. Van den Berghe, F. de Zegher, D. Vlasselaers, M. Schetz, C. Verwaest, P. Ferdinande, et al.
Thyrotropin-releasing hormone in critical illness: From a dopamine-dependent test to a strategy for increasing low serum triiodothyronine, prolactin, and growth hormone concentrations.
Crit Care Med, 24 (1996), pp. 590-595
[63.]
P. Woolf, L. Lee, R. Hamill, J.V. Mac Donald.
Thyroid test abnormalities in traumatic brain injury: Correlation with neurologic impairment and sympathetic nervous system activation.
Am J Med, 84 (1988), pp. 201-258
[64.]
P.M. Rothwell, Z.F. Udwadia, P.G. Lawler.
Thyrotropin concentration predicts outcome in critical illness.
Anaesthesia, 48 (1993), pp. 373-376
[65.]
W.J. Carter, K.M. SHakir, S. Hodges, F.H. Faas, J.O. Wynn.
Effect of thyroid hormone on metabolic adaptation to fasting.
Metabolism, 24 (1975), pp. 1.177-1.183
[66.]
M.M. Berger, T. Lemarchand-Béraud, C. Cavadini, R. Chioléro.
Relations between the selenium status and the low T3 syndrome after major trauma.
Intensive Care Med, 22 (1996), pp. 575-581
[67.]
R.D. Utiger.
Decreased extrathyroidal triiiodothyronine production in nonthyroidal illness. Benefit or harm.
Am J Med, 69 (1980), pp. 807-810
[68.]
M.G. Ziegler, E.C. Morrissey, L.F. Marshall.
Cathecolamine and thyroid hormones in traumatic injury.
Crit Care Med, 18 (1990), pp. 253-258
[69.]
G.A. Brent, J.M. Hershman.
Thyroxine therapy in patients with severe nonthyroidal illnesses and low serum thyroxine concentration.
J Clin Endocrinol Metab, 63 (1986), pp. 1-8
[70.]
E. Bennet-Guerrero, J.L. Jiménez, W.D. White, E.B. D’Amico, B.I. Baldwin, D.A. Schwinn.
Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass grafting. A randomized, double-blind, placebo-controlled trial.
JAMA, 275 (1996), pp. 687-692
[71.]
G. Van den Berghe, F. De Zegher.
A senescent pattern of pituitary function during critical illness and dopamine treatment.
Verh K Acad Geneeskd Belg, 58 (1996), pp. 383-411
[72.]
A. Grossman.
Brain opiates and neuroendocrine function.
Clin Endocrinol Metab, 12 (1983), pp. 725-746
[73.]
T.J. Luger, R. Fassler, M. Gottardis, W. Koller, N. Mutz.
The behavior of GH and somatomedin C following anesthesia induction with propofol in comparison with diazepam and thiopental.
Anasth Intensivther Notfallmed, 24 (1989), pp. 226-230
[74.]
A. Kertesz, G. Godo, G. Falkay, M. Boros.
Plasma cortisol, prolactin and thyroxine levels related to midazolam anaesthesia.
Acta Med Hung, 43 (1986), pp. 283-289
[75.]
R. Chioléro, T. Lemarchand, Y. Schutz, N. de Tribolet, M. Bayer-Berger, J. Freeman.
Thyroid function in severely traumatized patients with or without head injury.
Acta Endocrinol (Copenh, 117 (1988), pp. 80-86
[76.]
E.M. Kaptein, J.M. Weiner, W.J. Robinson, W.S. Wheeler, T.J. Nicoloff.
Relationship of altered thyroid hormone indices to survival in nonthyroidal illnesses.
Clin Endocrinol, 16 (1982), pp. 565-574
[77.]
L.S. Maldonado, G.H. Murata, J.M. Hershman, G.D. Braunstein.
Do Thyroid function tests independently predict survival in the critically ill?.
Thyroid, 2 (1992), pp. 119-123
[78.]
D.C Ray, G.B. Drummond, E. Wilkinson, G.J. Beckett.
Relationship of admission thyroid function tests to outcome in critical illness.
Anaesthesia, 50 (1995), pp. 1.022-1.025
[79.]
K.C. Loh, P.C.T. Eng.
Prevalence and prognostic relevance of sick euthyroid syndrome in a medical intensive care unit.
Ann Acad Med Singapore, 24 (1995), pp. 802-806
[80.]
M. León Sanz, J.A. Lorente, L. Larroder, P. Ros, J. Álvarez, A.E. Esteban, et al.
Pituitary-thyroid function in patients with septic shock and its relation with outcome.
Eur J Med Res, 11 (1997), pp. 477-482
[81.]
Y.T. Mak, E.L.P. Chan, A. Chan, J. Woo, R. Swaminathan.
Free thriyodotironine in sera of acutely ill general medical patients. A prognostic indicator.
Clin Chem, 38 (1992), pp. 414-415
[82.]
J.M. Hackl, M. Gottardis, C.H. Wieser, E. Rumpl, C. Stadler, S. Schwarz, et al.
Plasma pituitary hormone levels in severe trauma with or without head injury.
J Trauma, 17 (1991), pp. 25-29
[83.]
F. Della Corte, A. Mancini, D. Valle, F. Gallizzi, P. Carducci, V. Mignani, et al.
Provocative hypothalamopituitary axis tests in severe head injury: Correlation with severity and prognosis.
Crit Care Med, 26 (1998), pp. 1.419-1.426
[84.]
G. McLeod, J. Dick, C. Wallis, A. Patterson, C. Cox, J. Colvin.
Propofol 2%: Effect on lipids.
Crit Care Med, 25 (1997), pp. 1.976-1.981
[85.]
D. Balogh, R. Moncayo, M. Bauer.
Hormonal dysregulations in severe burns.
Burns, 10 (1984), pp. 257-263
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