ArticleThe Journal of clinical endocrinology and metabolism2020
Dynamic Pituitary-Adrenal Interactions in the Critically Ill after Cardiac Surgery.
Article in The Journal of clinical endocrinology and metabolism, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 26 citations in OpenAlex.
- The dynamic adrenal response of children to cardiac surgery and cardiac catheterization.The Journal of clinical endocrinology and metabolism · 2026Article
- Critical care delirium: prevention, identification and management: a narrative review.Anaesthesia · 2026Review
- Regulation of ultradian pulsatility and stress responses in the human hypothalamic-pituitary-adrenal axis.Journal of neuroendocrinology · 2026Article
- Tracking inflammation status for improving patient prognosis: A review of current methods, unmet clinical needs and opportunities.Biotechnology advances · 2025Review
- Endocrine evaluation of patients hospitalized with COVID-19 infection: A cross sectional analyses in tertiary level hospital.Pakistan journal of medical sciences · 2024Article
- Adrenal insufficiency following cerebellar intracranial hemorrhage: a case report.Frontiers in neurology · 2024Article
- Serum ACTH and Cortisol Level is Associated with the Acute Gastrointestinal Injury Grade in ICU Patients.International journal of general medicine · 2024Article
- Sparse Deconvolution and Causality Analysis of Inflammatory Markers During Cardiac Surgery.Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference · 2023Article
- Characterizing Alterations in Cortisol Secretion During Cardiac Surgery.Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference · 2023Article
- Four-Compartment Diffusion Model of Cortisol Disposition: Comparison With 3 Alternative Models in Current Clinical Use.Journal of the Endocrine Society · 2022Article
- Article
- Modelling the dynamic interaction of systemic inflammation and the hypothalamic-pituitary-adrenal (HPA) axis during and after cardiac surgery.Journal of the Royal Society, Interface · 2022Article
- Decreased maximal cortisol secretion rate in patients with cirrhosis: Relation to disease severity.JHEP reports : innovation in hepatology · 2021Article
- Cortisol concentrations and mortality from COVID-19.The lancet. Diabetes & endocrinology · 2020Article
- Cortisol concentrations and mortality from COVID-19 - Authors' reply.The lancet. Diabetes & endocrinology · 2020Article
- COVID-19 infection and glucocorticoids: update from the Italian Society of Endocrinology Expert Opinion on steroid replacement in adrenal insufficiency.Journal of endocrinological investigation · 2020Review
- Could Exogenous Insulin Ameliorate the Metabolic Dysfunction Induced by Glucocorticoids and COVID-19?Frontiers in endocrinologyReview
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8 authors at 4 institutions in 3 countries.
Funding
Abstract
contextPatients with critical illness are thought to be at risk of adrenal insufficiency. There are no models of dynamic hypothalamic-pituitary-adrenal (HPA) axis function in this group of patients and thus current methods of diagnosis are based on aggregated, static models.
objectiveTo characterize the secretory dynamics of the HPA axis in the critically ill (CI) after cardiac surgery.
designMathematical modeling of cohorts.
settingCardiac critical care unit. PATIENTS: 20 male patients CI at least 48 hours after cardiac surgery and 19 healthy (H) male volunteers.
interventionsNone.
main outcome measuresMeasures of hormone secretory dynamics were generated from serum adrenocorticotrophic hormone (ACTH) sampled every hour and total cortisol every 10 min for 24 h.
resultsAll CI patients had pulsatile ACTH and cortisol profiles. CI patients had similar ACTH secretion (1036.4 [737.6] pg/mL/24 h) compared to the H volunteers (1502.3 [1152.2] pg/mL/24 h; P = .20), but increased cortisol secretion (CI: 14 447.0 [5709.3] vs H: 5915.5 [1686.7)] nmol/L/24 h; P < .0001). This increase in cortisol was due to nonpulsatile (CI: 9253.4 [3348.8] vs H: 960 [589.0] nmol/L/24 h, P < .0001), rather than pulsatile cortisol secretion (CI: 5193.1 [3018.5] vs H: 4955.1 [1753.6] nmol/L/24 h; P = .43). Seven (35%) of the 20 CI patients had cortisol pulse nadirs below the current international guideline threshold for critical illness-related corticosteroid insufficiency, but an overall secretion that would not be considered deficient.
conclusionsThis study supports the premise that current tests of HPA axis function are unhelpful in the diagnosis of adrenal insufficiency in the CI. The reduced ACTH and increase in nonpulsatile cortisol secretion imply that the secretion of cortisol is driven by factors outside the HPA axis in critical illness.
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