Publications

Critical illnesses are characterized by increased systemic cortisol availability, which is a vital part of the stress response. Relative adrenal failure (later termed critical-illness-related corticosteroid insufficiency (CIRCI)) is a condition in which the systemic availability of cortisol is assumed to be insufficiently high to face the stress of the illness and is most typically thought to occur in the acute phase of septic shock. Researchers ...

The hormone cortisol is an essential component of the response to stress to provide energy, reduce inflammation and ensure hemodynamic stability. Increased production and release of cortisol is normally driven by an activated hypothalamic-pituitary-adrenal (HPA) axis. However, our research group recently demonstrated low plasma ACTH concentrations and high plasma cortisol concentrations during critical illness. This is known as the ...

PURPOSE: Low plasma ACTH in critically ill patients may be explained by shock/inflammation-induced hypothalamus-pituitary damage or by feedback inhibition exerted by elevated plasma free cortisol. One can expect augmented/prolonged ACTH-responses to CRH injection with hypothalamic damage, immediately suppressed responses with pituitary damage, and delayed decreased responses in prolonged critical illness with feedback inhibition. METHODS: This ...

PURPOSE: For patients suffering from prolonged critical illness, it is unknown whether and when the hypothalamus-pituitary-adrenal axis alterations recover, and to what extent adrenocortical function parameters relate to sepsis/septic shock, to clinical need for glucocorticoid treatment, and to survival. METHODS: Patients still in ICU on day 7 (N = 392) and 20 matched healthy subjects were included. Morning blood and 24-h urine were collected ...

Critically ill patients have elevated plasma cortisol concentrations, in proportion to illness severity. This was traditionally attributed exclusively to a central activation of the hypothalamus-pituitary axis. However, low rather than high plasma ACTH concentrations have been reported in critically ill patients, with loss of diurnal ACTH and cortisol rhythm. Low ACTH together with high cortisol is referred to as "ACTH-cortisol dissociation." ...

OBJECTIVE: Critical illness is hallmarked by low plasma ACTH in the face of high plasma cortisol. We hypothesized that frequently used drugs could play a role by affecting the hypothalamic-pituitary-adrenal axis. DESIGN: Observational association study. PATIENTS: A total of 156 medical-surgical critically ill patients. MEASUREMENTS: Plasma concentrations of ACTH and total/free cortisol were quantified upon ICU admission and throughout the first ...

Nutrition can affect the hypothalamus-pituitary-adrenal axis. We hypothesized that early administration of parenteral nutrition (PN) during critical illness reduces plasma ACTH and cortisol concentrations and hereby increases the use of corticosteroids. This is a preplanned substudy of a randomized controlled trial (EPaNIC) which compared early PN with late PN in 4640 critically ill patients. We investigated the impact of early versus late PN on ...

For decades, elevated plasma cortisol concentrations in criticaly ill patients were exclusively ascribed to a stimulated hypothalamus-pituitary-adrenal axis with increased circulating adrenocorticotropic hormone (ACTH) inferred to several-fold increase adrenal cortisol synthesis. However, 'ACTH-cortisol dissociation' has been reported during critical illness, referring to low circulating ACTH coinciding with elevated circulating cortisol. It was ...