重症病人的内分泌功能紊乱--培训课件.ppt

重症患者内分泌紊乱 发生率高 与预后相关 值得临床关注 下丘脑：TRH（促甲状腺激素释放激素）；GnRH（促性腺激素释放激素）；GHIH * acute phase of illness (first hours to a few days after onset)：the secretory activity of the anterior pituitary is essentially maintained or amplified, anabolic target organ hormones are inactivated, Cortisol levels are elevated in concert with ACTH. chronic phase of protracted critical illness (intensive care dependent for weeks), the secretory activity of the anterior pituitary suppressed, stimulating target endocrine organs circulating levels of target organ hormones reduce. levels of cortisol remain elevated through a peripheral drive, The onset of recovery is characterized by restored sensitivity of the anterior pituitary to reduced feedback control. * Figure 1 . The receiver operating curves for outcome prediction of the Endocrine Index (solid line) and APACHE II scores (dashed line). * * * Why ACTH levels are low in the presence of high serum cortisol levels in prolonged critical illness : There may be a loss of the negative feedback mechanism ; it may be that cortisol is released from sources outside the adrenal cortex(Endothelin and atrial natiuretic peptide have been implicated as sources of cortisol); levels of free cortisol increase as neutrophils liberate cortisol from corticosteroid binding globulin; in?ammatory cytokines increase tissue cortisol levels by changing peripheral cortisol metabolism and increasing the af?nity of glucocorticoid receptors for cortisol; cortisol clearance from the circulation is impaired in many critically ill patients * * Combination of thyroid laboratory values in the study population.Values are presented as percentage (n = 220). Ninety-seven (44.1%) had low serum FT3 levels indicating an NTIS, either with normal (52 patients, 23.6%) or reduced (45 patients, 20.5%) serum TSH levels. * A, Duration of stay at the ICU for euthyroid patients, patients with NTIS, and patients with other thyroid hormone changes. Results are shown as box plots with the to