• Anna Teresa Mazzeo, Federica Guaraldi, Claudia Filippini, Rachele Tesio, Fabio Settanni, Manuela Lucchiari, Giulio Mengozzi, Silvia Grottoli, Ezio Ghigo, and Luciana Mascia.
• Anestesiologia e Rianimazione, Dipartimento di Scienze Chirurgiche, Università di Torino, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy. Electronic address: anna.mazzeo@unito.it.
• J Crit Care. 2019 Dec 1; 54: 22-29.

PurposeCritical illness is a life threatening condition inducing a severe acute physical stress. The aim of the study was to investigate the activation of pituitary axis early after ICU admission in patients with critical illnesses of different etiology and its association with outcome.Materials And MethodsPatients admitted for acute respiratory distress syndrome (ARDS), severe traumatic brain injury (TBI), subarachnoid hemorrhage (SAH) and neurocritically ill patients at the moment of brain death (BD) diagnosis were included in the present post-hoc analysis. On day 1, 2-3 and 4-5 after admission the following pituitary axes were assessed: hypothalamic-pituitary-adrenal, hypothalamic-pituitary-thyroid, somatotroph, prolactin and copeptin. ICU mortality was used as outcome measure.ResultsOne hundred-thirteen critical ill patients were studied. Thyroid axis suppression and activation of copeptin axis were the most frequent pituitary hormone alterations, present in almost 60% of patients. Activation of the hypothalamic pituitary adrenal axis was a predictor of ICU mortality independently from the underlying critical illness [OR 3.952 (C.I.95% 1.129-13.838)].ConclusionsPituitary axis function is frequently altered early after ICU admission, the magnitude of hormonal response being different according to the underlying critical illness. The activation of the hypothalamic pituitary adrenal axis was a strong predictor of ICU mortality.Copyright © 2019 Elsevier Inc. All rights reserved.

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