Cortisol response in relation to the severity of stress and illness

Détails

ID Serval
serval:BIB_8152F74D2CF2
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Cortisol response in relation to the severity of stress and illness
Périodique
Journal of Clinical Endocrinology and Metabolism
Auteur(s)
Widmer  I. E., Puder  J. J., Konig  C., Pargger  H., Zerkowski  H. R., Girard  J., Muller  B.
ISSN
0021-972X
Statut éditorial
Publié
Date de publication
08/2005
Peer-reviewed
Oui
Volume
90
Numéro
8
Pages
4579-86
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't --- Old month value: Aug
Résumé
BACKGROUND: The aim of the study was to compare the adrenal response, the course of the ACTH/cortisol ratio, as well as the variance and the diagnostic performance of different cutoffs after 1 and 250 microg ACTH stimulation in different stress situations. METHODS: We investigated three groups with increasing stress levels: ambulatory controls (group A; n = 20), hospitalized medical patients (group B; n = 25), and patients undergoing coronary artery bypass grafting (group C; n = 29). All subjects underwent four consecutive ACTH stimulation tests and were randomized to either a 1- or 250-microg dose. RESULTS: Stimulated cortisol levels in group A were similar to basal cortisol levels under maximal stress (C3; P = 0.8). Peak cortisol concentrations were higher after 250 microg compared with 1 microg ACTH in group B (P = 0.006) and under maximal stress after extubation (group C3; P = 0.027), whereas there were no differences in group A. The ACTH/cortisol ratio was lower in surgical patients after extubation compared with unstressed conditions (P < or = 0.03) The within-subject variance was similar in ambulatory controls and medical patients and after both ACTH doses (all 17-36% of total variance). Cutoff dependent, the diagnosis of relative adrenal insufficiency would have been made in 0-58.3%, respectively. CONCLUSION: In moderate and major stress situations, cortisol concentrations in patients without hypothalamic-pituitary-adrenal disease were higher after stimulation with 250 microg compared with 1 mug ACTH. Data from our study give insight into the physiological adaptations of the hypothalamic-pituitary-adrenal axis to stress.
Mots-clé
Adaptation, Physiological Adrenocorticotropic Hormone/administration & dosage/blood/*diagnostic use Adult Aged Coronary Artery Bypass Coronary Artery Disease/*blood/surgery Diagnostic Techniques, Endocrine/standards Female Humans Hydrocortisone/*blood Hypothalamo-Hypophyseal System/physiology Male Middle Aged Pituitary-Adrenal System/physiology Reproducibility of Results *Severity of Illness Index Stress/*blood/diagnosis
Pubmed
Web of science
Open Access
Oui
Création de la notice
15/02/2008 18:19
Dernière modification de la notice
20/08/2019 15:41
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