Serious Illness Causes Too Much Cortisol

(Ivanhoe Newswire) -- Hypercortisolemia, when there are high amounts of circulating cortisol in the body, is sometimes the result of continuous stress or depression. Considering the causes, it’s no wonder patients with a critical illness often experience hypercortisolemia as well. Now, researchers are trying to explain why critically ill patients also tend to have low corticotropin levels and a new study suggests reduced cortisol metabolism may be to blame.
In the study, researchers tested five aspects of cortisol metabolism in 158 critically ill patients as well as 64 controls. The aspects measured were the participants’ levels of urinary cortisol metabolites, daily levels of corticotropin and cortisol, plasma clearance of 100 mg of hydrocortisone, levels of messenger RNA and protein in liver and adipose tissue, and plasma cortisol clearance, metabolism, and production.
As expected, critically ill participants had an 83% higher production of cortisol and lower corticotropin levels when compared to the control group. After looking at the plasma clearance of hydrocortisone and the plasma cortisol clearance, it became evident that participants in the intensive care unit do have reduced cortisol metabolisms. In fact, these participants had 50% less cortisol clearance than the healthy controls.
Furthermore, researchers discovered a link between decreased cortisol clearance and lower cortisol response to corticotropin stimulation as well as reduced inactivation of cortisol in the liver and kidney.
Although the study reveals cortisol-metabolizing enzymes are impaired during critical illness leading to hypercortisolemia and low levels of corticotropin, how to help these individuals is still unclear. Hopefully future studies will figure out a safe way to speed up cortisol metabolism in people dealing with extremely stressful situations, such as a serious illness.
SOURCE: New England Journal of Medicine, April 2013