Corticosteroid Therapy in Severe Illness

Lamberts, Steven W. J.; Bruining, H. A.; Jong, Frank H. de

doi:10.1056/nejm199710303371807

Cited by 448 publications

(300 citation statements)

References 87 publications

Supporting

Mentioning

264

Contrasting

Unclassified

Order By: Relevance

“…These observations are in line with the studies reporting up to 5 to 15-fold increased blood cortisol levels of critically ill-patients, such as patients with septic shock or massive bleeding (Uete et al, 1970;Sandberg et al, 1956;Jurney et al, 1987;Schroeder et al, 2001;Lamberts et al, 1997;Aygen et al, 1997). Since a positive correlation was observed between the degree of elevation of endogenous cortisol levels and the survival rate in critical disease conditions, the strong increase in endogenous cortisol is presumed to be a protective reflex of the organism against a fatal threat (Schroeder et al, 2001;Lamberts et al, 1997;Aygen et al, 1997;Reincke et al, 1993;Garcia Garcia et al, 2001;Shimada et al, 2000;Bollaert et al, 1998). High-dose glucocorticoids are, therefore, often used as supportive medication for critically ill patients in intensive care units (Shimada et al, 2000;Bollaert et al, 1998).…”

Section: Introductionsupporting

confidence: 91%

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Erkut

Klooker

Endert

et al. 2003

Neuropsychopharmacol

View full text Add to dashboard Cite

Hypothalamo-pituitary-adrenal (HPA)-axis activation is a response of the organism to psychological and physical stress, resulting in elevated levels of glucocorticoids, mainly cortisol in humans. In our previous studies we found post-mortem blood and cerebrospinal fluid (CSF) cortisol levels to be up to 20-fold higher than in vivo levels. Since clinical observations point to similar strong elevations of cortisol in fatally ill patients, we suggested that the high post-mortem cortisol levels might be due to the stress during the process of dying. We hypothesized that if the cortisol rise during dying is due to the psychological stress of the impending death, then the rise in cortisol should be inversely proportional to the degree of dementia, and that high-dose morphine giving analgesia, sedation, and sleep would suppress this response. Therefore, we measured the cortisol levels by radioimmunoassay (RIA) in the post-mortem CSF of 85 Alzheimer patients and 52 controls. In addition, post-mortem serum cortisol of 17 subjects from the Alzheimer group and nine from the control group were measured. The Alzheimer patients were subdivided according to their degree of dementia, as scored on the Reisberg Scale, before their death. All groups were further analyzed for the effect of morphine treatment, as well as for the effects of the confounding factors like age, gender, time, and season of death. Alzheimer patients had significantly higher cortisol levels than controls, both in CSF (mean (nmol/ l) 7 SEM: 482 7 32 vs 285 7 30, respectively, po0.001) and in serum (2854 7 279 vs 1533 7 395, p ¼ 0.011). Mean CSF cortisol level of the severely demented Alzheimer group was even significantly higher than that of mildly demented group (508 7 35 vs 225 7 65, p ¼ 0.024) and controls (po0.001). Cortisol levels correlated positively with the degree of dementia in the Alzheimer group (r ¼ 0.236, p ¼ 0.035). High-dose morphine did not cause a suppression of cortisol rise, neither in controls nor in Alzheimer patients. Our results indicate that the extreme elevations of cortisol levels during dying are rather due to the organic stress of the organism than to psychological stress of the patient, and is not suppressed by high-dose morphine.

show abstract

Section: Introductionsupporting

confidence: 91%

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Erkut

Klooker

Endert

et al. 2003

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…Furthermore, many cancer patients receiving chemotherapy often suffer from chemotherapy-related adverse events including severe myelosuppression and infection. The potential impact of even mild adrenal insufficiency in these patients can be hazardous because cortisol has vital circulatory effects in response to stress [28].…”

Section: Discussionmentioning

confidence: 99%

A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Han

Park

et al. 2015

The Oncologist

View full text Add to dashboard Cite

Background. In a previous pilot study, adrenal suppression was found to be common after antiemetic dexamethasone therapy in cancer patients.The objective of this large prospective multicenter study was to confirm the incidence and factors associated with secondary adrenal suppression related to antiemetic dexamethasone therapy in cancer patients receiving chemotherapy. Methods. Chemotherapy-naïve patients who were scheduled to receive at least three cycles of highly or moderately emetogenic chemotherapy with dexamethasone as an antiemetic were enrolled. Patients with a suppressed adrenal response before chemotherapy or those administered corticosteroids within 6 months of enrollment in the study were excluded. Results. Between October 2010 and August 2014, 481 patients receiving chemotherapy underwent the rapid adrenocorticotropic hormone (ACTH) stimulation test to assess eligibility; 350 of these patients were included in the final analysis. Fifty-six

show abstract

“…This latter condition has been described as 'relative adrenal insufficiency' with cortisol concentrations that may be appropriate for normal functioning, yet are inadequate in the setting of acute illness or prematurity. 11,12 While the standard therapy for hypotension has included volume expansion with colloid or crystalloid and the administration of inotropic agents, glucocorticoids have been used successfully in patients with cardiovascular compromise related to adrenal dysfunction. 5,6,11,[13][14][15][16] Because of concerns over short-and longterm side effects with dexamethasone, [17][18][19] hydrocortisone (HC) has been used as an alternative glucocorticoid.…”

Section: Introductionmentioning

confidence: 99%

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

View full text Add to dashboard Cite

Objective: The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment.Study Design: This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 mg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC.Result: Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol.Conclusion: HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

show abstract

Corticosteroid Therapy in Severe Illness

Cited by 448 publications

References 87 publications

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

Stress of Dying is not Suppressed by High-dose Morphine or by Dementia

A Prospective Multicenter Study Evaluating Secondary Adrenal Suppression After Antiemetic Dexamethasone Therapy in Cancer Patients Receiving Chemotherapy: A Korean South West Oncology Group Study

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Contact Info

Product

Resources

About