Pattern of endocrine changes in moderate to severely ill
patients in a medical
intensive care unit, correlation with the
severity of illness and whether these changes can predict outcome of the
critically ill patients were evaluated and studied in 80
patients admitted with
acute physiology and chronic health evaluation (
APACHE) II score >10 and without any pre-existing endocrinopathies or on
drugs likely to
affect the endocrine axis.
Adrenal insufficiency was present in 45%, and
mortality was higher in those with lower (<15 microg/dl) and higher (>30 microg/dl)
serum cortisol.
Sick euthyroid syndrome was detected in 80%, and those with low mean T3 (<0.6 ng/ml), free T4 (<0.89 ng/dl) and total T4 (<4 microg/dl) and had increased
mortality. Hypotestosteronaemia was found in 92% of
men and was significantly associated with
severity of illness in
men. Though
prolactin is the first
hormone to be elevated, there was no correlation between
prolactin and
severity of illness or
mortality.