Endocrinology in the Critically Ill

The neuroendocrine responses to acute and prolonged critical illness are substantially different. In the acute phase, the adaptations are probably beneficial in the struggle for short-term survival, whereas the chronic alterations may be maladaptive and participate in the general wasting syndrome of prolonged critical illness. Thorough understanding of the pathophysiology underlying these distinct neuroendocrine alterations during acute and prolonged critical illness is vital when considering new therapeutic strategies to correct these abnormalities and, as such, open perspectives to improve survival. Indeed, adequate choice of hormone and corresponding dosage are crucial and depend on such insights. The concomitant administration of presumed deficient (hypothalamic) releasing factors holds promise as an effective and safe intervention to jointly restore the corresponding axes and to counteract the hypercatabolic state of prolonged critical illness.