Prolonged critical illness has high morbidity and mortality. The acute neuroendocrine response to critical illness involves an activated anterior pituitary function. In prolonged critical illness, however, a reduced pulsatile secretion of anterior pituitary hormones and the so-called 'wasting syndrome' occur. The impaired pulsatile secretion of growth hormone (GH), thyrotropin and gonadotropin can be re-amplified by relevant combinations of releasing factors, which also substantially increase circulating levels of insulin-like growth factor (IGF)-I, GH-dependent IGF-binding proteins, thyroxine, tri-iodothyronine, and testosterone. Anabolism is clearly re-initiated when GH secretagogues, thyrotropin-releasing and gonadotropin-releasing hormones are co-administered but the effect on survival remains unknown. A lethal outcome of critical illness is predicted by a high serum concentration of IGF-binding protein 1, pointing to impaired insulin effect rather than pituitary function, and survival was recently shown to be dramatically improved by strict normalization of glycemia with exogenous insulin. The recent progress in the knowledge of the neuroendocrine response to critical illness and its interrelation with peripheral hormonal and metabolic alterations during stress allows for potential new therapeutic perspectives to safely reverse the wasting syndrome and improve survival. These novel insights will be reviewed herein.

中文翻译：

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危重疾病的动态神经内分泌反应

长期危重病具有较高的发病率和死亡率。对危重疾病的急性神经内分泌反应涉及激活的垂体前叶功能。然而，在长期危重疾病中，会出现垂体前叶激素搏动性分泌减少和所谓的“消瘦综合征”。生长激素 (GH)、促甲状腺激素和促性腺激素的脉动分泌受损可以通过相关的释放因子组合重新放大，这也显着增加胰岛素样生长因子 (IGF)-I、GH 依赖性 IGF 结合的循环水平蛋白质、甲状腺素、三碘甲状腺原氨酸和睾酮。当同时使用 GH 促分泌素、促甲状腺激素释放激素和促性腺激素释放激素时，合成代谢明显重新开始，但对生存的影响仍然未知。危重疾病的致命结果是通过高血清浓度的 IGF 结合蛋白 1 来预测的，这表明胰岛素作用受损，而不是垂体功能受损，并且最近显示，通过使用外源性胰岛素使血糖严格正常化，存活率显着提高。对危重疾病的神经内分泌反应及其与压力期间外周激素和代谢改变的相互关系的最新进展，为安全逆转消耗综合征和提高生存率提供了潜在的新治疗视角。这些新颖的见解将在本文中进行审查。最近显示，通过使用外源性胰岛素使血糖严格正常化，存活率显着提高。对危重疾病的神经内分泌反应及其与压力期间外周激素和代谢改变的相互关系的最新进展，为安全逆转消耗综合征和提高生存率提供了潜在的新治疗视角。这些新颖的见解将在本文中进行审查。最近显示，通过使用外源性胰岛素使血糖严格正常化，存活率显着提高。对危重疾病的神经内分泌反应及其与压力期间外周激素和代谢改变的相互关系的最新进展，为安全逆转消耗综合征和提高生存率提供了潜在的新治疗视角。这些新颖的见解将在本文中进行审查。