TAILIEUCHUNG - Báo cáo y học: "he adrenocorticotropic hormone-induced cortisol response in acute pancreatitis AB Johan Groeneveld"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The adrenocorticotropic hormone-induced cortisol response in acute pancreatitis AB Johan Groeneveld. | Available online http content 13 5 186 Commentary The adrenocorticotropic hormone-induced cortisol response in acute pancreatitis AB Johan Groeneveld Department of Intensive Care VUmc 1082 AR Amsterdam The Netherlands Corresponding author AB Johan Groeneveld Published 16 September 2009 This article is online at http content 13 5 186 2009 BioMed Central Ltd Critical Care 2009 13 186 doi cc8018 See related research by Peng et al. http content 13 4 R123 Abstract The evidence that severe acute pancreatitis can result in critical illness-related corticosteroid insufficiency following impaired adrenal secretion is accumulating. The study by Peng and coworkers in Critical Care certainly contributes to that idea even though the question whether relative adrenal insufficiency should prompt for treatment by substitution doses of corticosteroids remains unresolved. The study is discussed in terms of the risk factors circumstances and significance of impaired corticosteroid secretion by adrenals in severe acute pancreatitis. In a recent issue of Critical Care Peng and coworkers 1 elegantly document a relatively low circulating cortisol response to adrenocorticotropic hormone ACTH stimulation in non-survivors versus a normal response in survivors of acute biliary pancreatitis. This was associated with more frequent bacteremia and severe disease. In fact the ACTH-induced cortisol response inversely related to disease severity measures as noted before 2 . None of the patients were treated by adrenal substitution doses of corticosteroids even though often suffering from septic shock as can be deduced from the data likely associated with infection of pancreatic necrosis and subsequent bacteremia as commonly occurs in severe cases 3 . Hence it was suggested that insufficient adrenal cortisol secretion reserve relative to severity of disease contributed to a poor outcome reflecting critical illness-related .

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