Περίληψη:
The function of the hypothalamic-pituitary-adrenal axis as related to
the degree of severity of a septic process was assessed by measuring
plasma levels of beta-endorphin, ACTH and cortisol. Sixty-one cases of
postoperative patients treated at the intensive care unit were
classified into four groups according to the severity of infection:
Group 1 (control) included patients who did not show any sign of
infection, group 2 patients with sepsis, group 3 patients with septic
syndrome and group 4 patients with septic shock. Compared to G1
patients’ ACTH values (4.16+/-2.6 pg/ml), a statistically significant
increase in ACTH values in various stages of septicemia (p < 0.005) with
a noticeable difference also between G3 (7.11 +/- 3.7 pg/ml) and G4
(11.5 +/- 6.6 pg/ml) (p<0.05) was found. Differences were also observed
in beta-endorphin (with a level of significance between the several
groups of p=0.0001). Also, beta-endorphin values in G4 (40.6 +/- 30.3
pg/ml) differed significantly from each of G1 (17.5 +/- 6.6 pg/ml), G2
(21.1 +/- 11.3 pg/ml) and G3 (23.5 +/- 12 pg/ mi) (p<0.05). A
progressive hypercortisolemia was obvious, with values of G4 (37.2 +/-
15.6 mu g/dl) differing significantly from those of G1 (18 +/- 4.6 mu
g/dl) and G2 (24 +/- 8.4 mu g/dl) (p<0.05) and of G3 (28.5 +/- 12.3 mu
g/dl) from that of G1 (p < 0.05). Interestingly, a dissociation of ACTH,
beta-endorphin and cortisol was observed, in that the increased values
of beta-endorphin and cortisol, detected in the G3 were not associated
with a parallel increase in ACTH. These findings might be interpreted in
the sense of an impairment of the stress stimulation of the hypothalamic
pituitary adrenal axis. Provided that such a situation can be lethal,
our results further confirm the idea that a low-dose, steroid
replacement might be beneficial to critical illness.
Συγγραφείς:
Legakis, I
Saramantis, A
Voros, D
Chalevelakis, G
Tolis,
G
