Endokrinologische Störungen bei Intensivpatienten

Einleitung

Die klassischen endokrinen Syndrome, wie z. B. die thyreotoxische Krise oder primäre Nebennierenrindendysfunktionen, führen relativ selten zu manifesten Organstörungen und erfordern nur in Einzelfällen eine Therapie auf der Intensivstation. Sehr häufig treten jedoch Veränderungen der endokrinen und metabolischen Regulation auf, die im Rahmen verschiedener Grunderkrankungen extra-endokrinen Ursprungs entstehen. In den letzten Jahren rückten diese Erkrankungen zunehmend in den Brennpunkt intensivmedizinischen Interesses [1], da sie eine bedeutsame Rolle in der Entwicklung des Multiorganversagens kritisch kranker Patienten spielen können. Veränderungen der endokrinen Regelkreise können also gleichzeitig Ursache und Folge von lebensbedrohlichen Krankheitsbildern sein.

Da es schwer abzuschätzen ist, welche Facette der endokrinen Veränderungen positiv und welche negativ für das Überleben schwerer Erkrankungen sind, müssen Interventionen in endokrine Regelkreise mit großer Vorsicht erfolgen.

Literatur

• 1 Ellger B, Debaveye Y, Van den Berghe G. Endocrine interventions in the ICU.  Eur J Intern Med. 2005;  16 71-82
• 2 Van den Berghe G. Dynamic neuroendocrine responses to critical illness.  Front Neuroendocrinol. 2002;  23 370-391
• 3 Debaveye Y, Van den Berghe G. Is there still a place for dopamine in the modern intensive care unit?.  Anesth Analg. 2004;  98 461-468
• 4 Kitabchi A E, Umpierrez G E, Murphy M B. et al . Management of hyperglycemic crises in patients with diabetes.  Diabetes Care. 2001;  24 131-153
• 5 The Diabetes Control and Complications Trial Research Group . Hypoglycemia in the Diabetes Control and Complications Trial.  Diabetes. 1997;  46 271-286
• 6 Krinsley J S. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients.  Mayo Clin Proc. 2003;  78 1471-1478
• 7 Van den Berghe G. How does blood glucose control with insulin save lives in intensive care?.  J Clin Invest. 2004;  114 1187-1195
• 8 Pittas A G, Siegel R D, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials.  Arch Intern Med. 2004;  164 2005-2011
• 9 Ellger B, Debaveye Y, Vanhorebeek I. et al . Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemia-independent actions of insulin.  Diabetes. 2006;  55 1096-1105
• 10 Van den Berghe G, Wouters P, Weekers F. et al . Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
• 11 Krinsley J S. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients.  Mayo Clin Proc. 2004;  79 992-1000
• 12 Van den Berghe G, Wilmer A, Hermans G. et al . Intensive insulin therapy in the medical ICU.  N Engl J Med. 2006;  354 449-461
• 13 Van den Berghe G, Wilmer A, Milants I. et al . Intensive Insulin Therapy in Mixed Medical/Surgical intensive Care Units. Benefit versus Harm.  Diabetes. 2006;  55 3151-3160
• 14 Van den Berghe G, Wouters P J, Bouillon R. et al . Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control.  Crit Care Med. 2003;  31 359-366
• 15 Van den Berghe G. How does blood glucose control with insulin save lives in intensive care?.  J Clin Invest. 2004;  114 1187-1195
• 16 Brunkhorst F M, Engel C, Bloos F. et al . Intensive Insulin therapy and pentastarch resuscitation in severe sepsis.  N Engl J Med. 2008;  358 125-139
• 17 Ellger B, Westphal M, Stubbe H. et al . Blutzuckerkontrolle bei Patienten mit Sepsis und septischem Schock – Freund oder Feind?.  Anaesthesist. 2008;  57 43-48
• 18 Dellinger R P, Levy M M, Carlet J M. et al . Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.  Crit Care Med. 2008;  36 296-327
• 19 Van den Berghe G, Wouters P, Weekers F. et al . Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
• 20 Van den Berghe G, Wouters P J, Bouillon R. et al . Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control.  Crit Care Med. 2003;  31 359-366
• 21 Van den Berghe G. How does blood glucose control with insulin save lives in intensive care?.  J Clin Invest. 2004;  114 1187-1195
• 22 Krinsley J S. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients.  Mayo Clin Proc. 2004;  79 992-1000
• 23 Egi M, Bellomo R, Stachowski E. et al . Variability of blood glucose and short-term mortality in critically ill patients.  Anesthesiology. 2006;  105 244-252
• 24 Ali N A, O’Brien J M Jr, Dungan K. et al . Glucose variability and mortality in patients with sepsis.  Crit Care Med. 2008; 
• 25 Vogelzang M, Loef B G, Reqtien J G. et al . Computer-assisted glucose control in critically ill patients.  Intensive Care Med. 2008;  34 1421-1427
• 26 Krinsley J S. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients.  Mayo Clin Proc. 2004;  79 992-1000
• 27 Van den Berghe G, Wouters P, Weekers F. et al . Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
• 28 Roberts C G, Ladenson P W. Hypothyroidism.  Lancet. 2004;  363 793-803
• 29 Cooper D S. Hyperthyroidism.  Lancet. 2003;  362 459-468
• 30 Stathatos N, Levetan C, Burman K D. et al . The controversy of the treatment of critically ill patients with thyroid hormone.  Best Pract Res Clin Endocrinol Metab. 2001;  15 465-478
• 31 Van den Berghe G, Baxter R C, Weekers F. et al . The combined administration of GH-releasing peptide-2 (GHRP-2), TRH and GnRH to men with prolonged critical illness evokes superior endocrine and metabolic effects compared to treatment with GHRP-2 alone.  Clin Endocrinol (Oxf). 2002;  56 655-669
• 32 Takala J, Ruokonen E, Webster N R. et al . Increased mortality associated with growth hormone treatment in critically ill adults.  N Engl J Med. 1999;  341 785-792
• 33 Van den Berghe G, Baxter R C, Weekers F. et al . The combined administration of GH-releasing peptide-2 (GHRP-2), TRH and GnRH to men with prolonged critical illness evokes superior endocrine and metabolic effects compared to treatment with GHRP-2 alone.  Clin Endocrinol (Oxf). 2002;  56 655-669
• 34 Marik P E, Pastores S M, Annane D. et al . Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statement from an international task force by the American College of Critical Care Medicine.  Crit Care Med. 2008;  36 1937-1948
• 35 Annane D, Sebille V, Troche G. et al . A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin.  JAMA. 2000;  283 1038-1045
• 36 Peter J V, John P, Graham P L. et al . Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis.  BMJ. 2008;  336 1006-1009
• 37 Coursin D B, Wood K E. Corticosteroid supplementation for adrenal insufficiency.  JAMA. 2002;  287 236-240
• 38 Hirshberg E, Larsen G, Van Duker H. Alterations in glucose homeostasis in the pediatric intensive care unit: hyperglycemia and glucose variability are associated with increased mortality and morbidity.  Pediatr Crit Care Med. 2008;  9 361-366
• 39 Wintergerst K A, Buckingham B, Gandrud L. et al . Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit.  Pediatrics. 2006;  118 173-179
• 40 Klein G W, Hojsak J M, Schmeidler J. et al . Hyperglycemia and outcome in the pediatric intensive care unit.  J Pediatr. 2008; 
• 41 Kong M Y, Alten J, Tofil N. Is hyperglycemia really harmful? A critical appraisal of „Persistent hyperglycemia in critically ill children” by Faustino and Apkon. (J Pediatr 2005; 146: 30 – 34).  Pediatr Crit Care Med. 2007;  8 482-485
• 42 Ross O C, Petros A. The sick euthyroid syndrome in paediatric cardiac surgery patients.  Intensive Care Med. 2001;  27 1124-1132
• 43 Bettendorf M, Schmidt K G, Grulich-Henn J. et al . Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study.  Lancet. 2000;  356 529-534
• 44 Sarthi M, Lodha R, Vivekanandhan S. et al . Adrenal status in children with septic shock using low-dose stimulation test.  Pediatr Crit Care Med. 2007;  8 23-28
• 45 Zimmerman J J. A history of adjunctive glucocorticoid treatment for pediatric sepsis: moving beyond steroid pulp fiction towards evidence-based medicine.  Pediatr Crit Care Med. 2007;  8 530-539