Critical illness as a model of hypothalamic ageing

Greet Van den Berghe and Stephen M. Shalet*1

Department of Intensive Care Medicine, University Hospital, Gasthuisberg, Catholic University of Leuven, Belgium and *Department of Endocrinology, Christie Hospital, Manchester, UK

Abstract. In this review we shall consider the endocrine changes seen in the various hypothalamic pituitary-target gland axes at different stages of critical illness and conclude by comparing these changes with those seen in the normal ageing process.

2002 Endocrine facets of ageing. Wiley, Chichester (Novartis Foundation Symposium 242) p205-221

By definition, 'critical illness' is any condition requiring support for failing vital organ functions, either with mechanical aids or with pharmacological agents, without which death would ensue — it is the ultimate example of acute severe physical stress. If onset of recovery does not follow within several days of intensive medical care, critical illness often becomes prolonged and intensive care must be continued for weeks or even months.

Patients previously died from these severe challenges, which include septic shock, multiple trauma or extensive burns. However, the survival mediated by intensive care is also associated with negative aspects. The highly technological intervention in the natural course of the dying process has unmasked previously unknown conditions, including a non-specific wasting syndrome: despite feeding, protein continues to be lost from vital organs and tissues due to increased proteolysis and decreased protein synthesis, whereas re-esterification of free fatty acids (FFAs) allows fat stores to build up (Streat et al 1987, Gamrin et al 1996). Moreover the muscle wasting is accompanied by hyperglycaemia, insulin resistance, hypoproteinaemia, hypercalcaemia, intracellular water and potassium depletion, and hypertriglyceridaemia, which often prompt symptomatic treatment.

1This paper was presented at the symposium by Stephen Shalet, to whom correspondence should be addressed.

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