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Role of endogenous glucocorticoid metabolism in human acute pancreatitis*

Muller, Christophe ; Vogeser, Michael ; Belyaev, Orlin ; Gloor, Beat ; Strobel, Oliver ; Weyhe, Dirk ; Werner, Jens ; Borgström, Anders LU ; Buchler, Markus and Uhl, Waldemar (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)
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organization
publishing date
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
2021-04-06 02:23:26
@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},
  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},
}