Role of endogenous glucocorticoid metabolism in human acute pancreatitis*
(2006) In Critical Care Medicine 34(4). p.1060-1066- Abstract
- Objective: This study aimed to observe how levels of total cortisol, calculated free cortisol, corticosteroid-binding globulin, and adrenocorticotropic hormone change during the early course of human acute pancreatitis and to describe how these changes affect the development of pancreatic necrosis. Design and Patients: In a total of 109 consecutive patients with acute pancreatitis (74 with edematous pancreatitis, 35 with necrotizing pancreatitis), serial daily blood monitoring of total and free cortisol, adrenocorticotropic hormone, and corticosteroid-binding globulin was done after hospital admission, up to day 6 after the onset of pain; 30 healthy individuals served as controls. Measurements. Corticosteroid-binding globulin and total... (More)
- Objective: This study aimed to observe how levels of total cortisol, calculated free cortisol, corticosteroid-binding globulin, and adrenocorticotropic hormone change during the early course of human acute pancreatitis and to describe how these changes affect the development of pancreatic necrosis. Design and Patients: In a total of 109 consecutive patients with acute pancreatitis (74 with edematous pancreatitis, 35 with necrotizing pancreatitis), serial daily blood monitoring of total and free cortisol, adrenocorticotropic hormone, and corticosteroid-binding globulin was done after hospital admission, up to day 6 after the onset of pain; 30 healthy individuals served as controls. Measurements. Corticosteroid-binding globulin and total cortisol were measured by immunoassays, and free cortisol was calculated according to Coolens et al. The adrenocorticotropic hormone was measured with an enzyme-linked immunoassay. Results, Initially, highly elevated levels of calculated free cortisol (median, 86.2 ng/mL; quartile ranges, 50.6-106.7 ng/mL) and total cortisol (41.2 mu g/dL, 30.4-51.1 mu g/dL) and depressed levels of adrenocarticotropic hormone (0.2 pg/mL, 0.1-2.0 pg/mL) and corticosteroid-binding globulin (30.6 mu g/mL, 24.1-35.5 mu g/mL) were observed. Further, daily measurements revealed increasing adrenocorticotropic hormone levels, whereas cortisol levels decreased. Conclusions: Although an increase in adrenocorticotropic hormone levels is suggested to increase corresponding cortisol levels, cortisol levels decreased during the development of necrotizing acute pancreatitis. This phenomenon, along with the continuously decreasing corticosteroid-binding globulin levels, brings up the hypothesis of a relative adrenal insufficiency, which favors acinar cell apoptosis and hence may trigger the development of necrosis in the initial vulnerable phase of acute pancreatitis. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/153464
- author
- Muller, Christophe ; Vogeser, Michael ; Belyaev, Orlin ; Gloor, Beat ; Strobel, Oliver ; Weyhe, Dirk ; Werner, Jens ; Borgström, Anders LU ; Buchler, Markus and Uhl, Waldemar
- organization
- publishing date
- 2006
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- relative adrenal insufficiency, acute necrotizing pancreatitis, total, cortisol, calculated free cortisol, corticosteroid-binding globulin, adrenocorticotropic hormone
- in
- Critical Care Medicine
- volume
- 34
- issue
- 4
- pages
- 1060 - 1066
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:16484908
- wos:000236303000018
- scopus:33644985545
- pmid:16484908
- ISSN
- 1530-0293
- DOI
- 10.1097/01.CCM.0000206285.69499.72
- language
- English
- LU publication?
- yes
- id
- ce561833-ce18-47b2-a6ff-23ec384ece73 (old id 153464)
- alternative location
- http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16484908&dopt=Abstract
- date added to LUP
- 2016-04-01 15:59:54
- date last changed
- 2022-03-22 07:43:35
@article{ce561833-ce18-47b2-a6ff-23ec384ece73,
abstract = {{Objective: This study aimed to observe how levels of total cortisol, calculated free cortisol, corticosteroid-binding globulin, and adrenocorticotropic hormone change during the early course of human acute pancreatitis and to describe how these changes affect the development of pancreatic necrosis. Design and Patients: In a total of 109 consecutive patients with acute pancreatitis (74 with edematous pancreatitis, 35 with necrotizing pancreatitis), serial daily blood monitoring of total and free cortisol, adrenocorticotropic hormone, and corticosteroid-binding globulin was done after hospital admission, up to day 6 after the onset of pain; 30 healthy individuals served as controls. Measurements. Corticosteroid-binding globulin and total cortisol were measured by immunoassays, and free cortisol was calculated according to Coolens et al. The adrenocorticotropic hormone was measured with an enzyme-linked immunoassay. Results, Initially, highly elevated levels of calculated free cortisol (median, 86.2 ng/mL; quartile ranges, 50.6-106.7 ng/mL) and total cortisol (41.2 mu g/dL, 30.4-51.1 mu g/dL) and depressed levels of adrenocarticotropic hormone (0.2 pg/mL, 0.1-2.0 pg/mL) and corticosteroid-binding globulin (30.6 mu g/mL, 24.1-35.5 mu g/mL) were observed. Further, daily measurements revealed increasing adrenocorticotropic hormone levels, whereas cortisol levels decreased. Conclusions: Although an increase in adrenocorticotropic hormone levels is suggested to increase corresponding cortisol levels, cortisol levels decreased during the development of necrotizing acute pancreatitis. This phenomenon, along with the continuously decreasing corticosteroid-binding globulin levels, brings up the hypothesis of a relative adrenal insufficiency, which favors acinar cell apoptosis and hence may trigger the development of necrosis in the initial vulnerable phase of acute pancreatitis.}},
author = {{Muller, Christophe and Vogeser, Michael and Belyaev, Orlin and Gloor, Beat and Strobel, Oliver and Weyhe, Dirk and Werner, Jens and Borgström, Anders and Buchler, Markus and Uhl, Waldemar}},
issn = {{1530-0293}},
keywords = {{relative adrenal insufficiency; acute necrotizing pancreatitis; total; cortisol; calculated free cortisol; corticosteroid-binding globulin; adrenocorticotropic hormone}},
language = {{eng}},
number = {{4}},
pages = {{1060--1066}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Critical Care Medicine}},
title = {{Role of endogenous glucocorticoid metabolism in human acute pancreatitis*}},
url = {{http://dx.doi.org/10.1097/01.CCM.0000206285.69499.72}},
doi = {{10.1097/01.CCM.0000206285.69499.72}},
volume = {{34}},
year = {{2006}},
}