The time course of adrenocortical hormones and cytokines in sepsis and/or septic shock

The present study was carried out to evaluate the time course of serum adrenocortical hormones and cytokines in critically ill patients with sepsis and/or septic shock. To this end, 56 patients (42 men) with a median age of 53 years (range 17–82 years) were investigated. At study entry, the mean APACHE score was 20 and the median SOFA score was 11. Blood was drawn to measure cortisol, corticotropin (ACTH), dehydroepiandrosterone-sulphate (DHEAS), IL-6 and tumor necrosis factor alpha (TNF-α) levels within 48 hours of the onset of sepsis and/or septic shock, and thereafter every second day for 14 days, or until death or ICU discharge. Median cortisol and DHEAS run in parallel and remained unchanged during the study period (17, 18, 17, 14, 17 and 18 μg/dl, P = 0.42, 1.188, 1.145, 1.190, 1.220 and 873; 1.202 ng/ml, P = 0.97, respectively). Median ACTH increased significantly during the entire observation period (21, 24, 28, 34, 32 and 43 pg/ml, P = 0.008). TNF-α levels were high and decreased gradually (2, 2, 1, 0, 0 and 0 pg/ml, P < 0.001). IL-6 concentrations were high initially, but decreased abruptly during the first week; thereafter, they reached a plateau (344, 215, 169, 118, 128 and 93 pg/ml, P < 0.001).

In conclusion, during the course of sepsis and/or septic shock, serum glucocorticoids and adrenal androgens do not change. During the first week, the hypothalamic–pituitary–adrenal axis is activated by both ACTH and IL-6; the axis is subsequently stimulated primarily by ACTH.