DISSOCIATION OF ACTH, BETA-ENDORPHIN AND CORTISOL IN GRADED SEPSIS

The function of the hypothalamic-pituitary-adrenal axis as related to the degree of severity of a septic process was assessed by measuring p lasma levels of beta-endorphin, ACTH and cortisol. Sixty-one cases of postoperative patients treated at the intensive care unit were classif ied into four groups according to the severity of infection: Group 1 ( control) included patients who did not show any sign of infection, gro up 2 patients with sepsis, group 3 patients with septic syndrome and g roup 4 patients with septic shock. Compared to G1 patients' ACTH value s (4.16+/-2.6 pg/ml), a statistically significant increase in ACTH val ues in various stages of septicemia (p < 0.005) with a noticeable diff erence also between G3 (7.11 +/- 3.7 pg/ml) and G4 (11.5 +/- 6.6 pg/ml ) (p<0.05) was found. Differences were also observed in beta-endorphin (with a level of significance between the several groups of p=0.0001) . Also, beta-endorphin values in G4 (40.6 +/- 30.3 pg/ml) differed sig nificantly from each of G1 (17.5 +/- 6.6 pg/ml), G2 (21.1 +/- 11.3 pg/ ml) and G3 (23.5 +/- 12 pg/ mi) (p<0.05). A progressive hypercortisole mia was obvious, with values of G4 (37.2 +/- 15.6 mu g/dl) differing s ignificantly from those of G1 (18 +/- 4.6 mu g/dl) and G2 (24 +/- 8.4 mu g/dl) (p<0.05) and of G3 (28.5 +/- 12.3 mu g/dl) from that of G1 (p < 0.05). Interestingly, a dissociation of ACTH, beta-endorphin and co rtisol was observed, in that the increased values of beta-endorphin an d cortisol, detected in the G3 were not associated with a parallel inc rease in ACTH. These findings might be interpreted in the sense of an impairment of the stress stimulation of the hypothalamic pituitary adr enal axis. Provided that such a situation can be lethal, our results f urther confirm the idea that a low-dose, steroid replacement might be beneficial to critical illness.