Conclusion

Hypopituitarism has adverse effects on metabolic and immunological homeostasis. Precise diagnosis and substitution therapy with glucocorticoids, growth hormone, thyroid hormones, and eventually androgens prevents evolution to a life-threatening condition and optimizes the potential for recovery from intercurrent illnesses.

Prolonged critical illness without pre-existing hypothalamic pituitary disease is also associated with metabolic and immunological malfunctions which determine morbidity and mortality. The management and prevention of the protein hypercatabolism and the anergy-type immune suppression remain primary objectives of critical care medicine and subjects of intense investigation. It is conceivable that iatrogenic suppression of pituitary function in critically ill patients should be avoided in order not to impair further their potential for recovery.

Whether or not the endogenously occurring hypopituitarism in the presence of elevated cortisol levels is to be considered beneficial, adaptation within current standards of intensive care remains at present controversial. Studies of the effects of substituting the different suppressed anterior pituitary axes during critical illness are warranted and should provide an answer to this question in the near future.

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