Management of Endocrinal Disturbances in Patients of Intensive Care Units
Ahmed Abdullah Abdel-Fatah Matar;
Abstract
The endocrine system is made up of endocrine glands that produce hormones, chemical substances released into the bloodstream to guide processes such as metabolism, growth, and sexual development. Hormones are also involved in regulating emotional life.
The endocrine and nervous systems work very closely together. The brain continuously sends instructions to the endocrine system, and in return receives feedback from the endocrine glands. Because of this intimate relationship, the nervous and endocrine systems are referred to as the neuroendocrine system.
Endocrinal emergencies pose unique challenges for the attending intensivist while managing critically ill patients. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. One of the common reasons for inability to timely diagnose an endocrinal failure in critically ill patients being the dominance of other severe systemic diseases and their clinical presentation. The timely diagnosis and administration of therapeutic interventions for these endocrine disorders can improve the outcome in critically ill patients. The timely diagnosis and administration of timely therapeutics in common endocrine disorders like severe thyroid disease, acute adrenal insufficiency and diabetic ketoacidosis significantly influence the outcome and prognosis.Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal.
Critical illness is defined as any life-threatening condition requiring support of vital organ functions to prevent imminent death. This condition can be evoked by a variety of insults such as multiple trauma, sepsis, complicated surgery, and severe medical illnesses. Due to critical care medicine, survival from previously lethal conditions has become possible, but many patients now enter a chronic phase of critical illness.
Critical illness is characterized by a uniform dysregulation of all hypothalamic anterior pituitary axises. The endocrine response to critical illness varies in two phases of critical illness. In the acute phase the pituitary is secreting actively, but the target organs are resistant and most of the peripheral hormones are low. These adaptations may be beneficial in the struggle for short term survival. In the prolonged phase there is uniform suppression of neuroendocrine axis which may be responsible for low target hormones. Prolonged critical illness is accompanied by ongoing hypercatabolism despite artificial feeding, which results in profound erosion of lean body mass in the presence of relative preservation of adipose tissue, induces weakness, and prolongs convalescence. In addition, patients become susceptible to infectious complications and are at risk for developing excessive systemic inflammation and coagulation disorders.
The high risk for morbidity and mortality in critically ill patients has led investigators to the introduction of certain endocrine treatments as new therapeutic strategies.Concomitant reactivation of the somatotropic, thyrotropic and gonadal axes with hypothalamic releasing factors holds promise as a safe therapy to reverse the neuroendocrine and metabolic abnormalities of prolonged critical illness.
The endocrine and nervous systems work very closely together. The brain continuously sends instructions to the endocrine system, and in return receives feedback from the endocrine glands. Because of this intimate relationship, the nervous and endocrine systems are referred to as the neuroendocrine system.
Endocrinal emergencies pose unique challenges for the attending intensivist while managing critically ill patients. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. One of the common reasons for inability to timely diagnose an endocrinal failure in critically ill patients being the dominance of other severe systemic diseases and their clinical presentation. The timely diagnosis and administration of therapeutic interventions for these endocrine disorders can improve the outcome in critically ill patients. The timely diagnosis and administration of timely therapeutics in common endocrine disorders like severe thyroid disease, acute adrenal insufficiency and diabetic ketoacidosis significantly influence the outcome and prognosis.Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal.
Critical illness is defined as any life-threatening condition requiring support of vital organ functions to prevent imminent death. This condition can be evoked by a variety of insults such as multiple trauma, sepsis, complicated surgery, and severe medical illnesses. Due to critical care medicine, survival from previously lethal conditions has become possible, but many patients now enter a chronic phase of critical illness.
Critical illness is characterized by a uniform dysregulation of all hypothalamic anterior pituitary axises. The endocrine response to critical illness varies in two phases of critical illness. In the acute phase the pituitary is secreting actively, but the target organs are resistant and most of the peripheral hormones are low. These adaptations may be beneficial in the struggle for short term survival. In the prolonged phase there is uniform suppression of neuroendocrine axis which may be responsible for low target hormones. Prolonged critical illness is accompanied by ongoing hypercatabolism despite artificial feeding, which results in profound erosion of lean body mass in the presence of relative preservation of adipose tissue, induces weakness, and prolongs convalescence. In addition, patients become susceptible to infectious complications and are at risk for developing excessive systemic inflammation and coagulation disorders.
The high risk for morbidity and mortality in critically ill patients has led investigators to the introduction of certain endocrine treatments as new therapeutic strategies.Concomitant reactivation of the somatotropic, thyrotropic and gonadal axes with hypothalamic releasing factors holds promise as a safe therapy to reverse the neuroendocrine and metabolic abnormalities of prolonged critical illness.
Other data
| Title | Management of Endocrinal Disturbances in Patients of Intensive Care Units | Other Titles | علاج اضطرابات الغدد الصماء للمرضى في الرعايات المركزة | Authors | Ahmed Abdullah Abdel-Fatah Matar | Issue Date | 2016 |
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