steroidogenesis in the adrenal dysfunction of critical illness impact of etomidate类固醇生成肾上腺功能障碍的关键疾病依托咪酯的影响.pdf

Molenaar et al. Critical Care 2012, 16:R121 /content/16/4/R121 RESEARCH Open Access Steroidogenesis in the adrenal dysfunction of critical illness: impact of etomidate 1† 1† 1 2 1 Nienke Molenaar , Ronald M Bijkerk , Albertus Beishuizen , Christel M Hempen , Margriet FC de Jong , 2 2 1 1* Istvan Vermes , Gertjan van der Sluijs Veer , Armand RJ Girbes and AB Johan Groeneveld Abstract Introduction: This study was aimed at characterizing basal and adrenocorticotropic hormone (ACTH)-induced steroidogenesis in sepsis and nonsepsis patients with a suspicion of critical illness-related corticosteroid insufficiency (CIRCI), taking the use of etomidate-inhibiting 11b-hydroxylase into account. Method: This was a prospective study in a mixed surgical/medical intensive care unit (ICU) of a university hospital. The patients were 62 critically ill patients with a clinical suspicion of CIRCI. The patients underwent a 250- μg ACTH test (n = 67). ACTH, adrenal steroids, substrates, and precursors (modified tandem mass spectrometry) also were measured. Clinical characteristics including use of etomidate to facilitate intubation (n = 14 within 72 hours of ACTH testing) were recorded. Results: At the time of ACTH testing, patients had septic (n = 43) or nonseptic critical illness (n = 24). Baseline cortisol directly related to sepsis and endogenous ACTH, independent of etomidate use. Etomidate was associated with a lower baseline cortisol and cortisol/11b-deoxycortisol ratio as well as higher 11b-deoxycortisol, reflecting greater 11b-hydroxylase inhibition in nonsepsis tha