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Dehydroepiandrosterone sulphate in critical illness: effect of dopamine
Author(s) -
Berghe Greet,
Zegher Francis,
Wouters Pieter,
Schetz Miet,
Verwaest Charles,
Ferdinande Patrick,
Lauwers Peter
Publication year - 1995
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1995.tb02618.x
Subject(s) - medicine , endocrinology , dopamine , prolactin , dehydroepiandrosterone sulfate , dehydroepiandrosterone , catecholamine , hydrocortisone , hormone , androgen
Summary OBJECTIVE As part of a study on the effect of dopamine therapy on pituitary dependent hormone secretion in critical illness, we documented the impact of this inotropic and vasoactive catecholamine on the serum concentrations of dehydroepiandrosterone sulphate (DHEAS). Concomitantly, serum levels of PRL and cortisol were determined. PATIENTS AND DESIGN In a prospective, randomized, controlled, open‐labelled clinical study, 20 critically ill, adult polytrauma patients receiving dopamine treatment (5 μg/kg/ml i.v. for a median 109 hours (range 21–296 hours), were studied to evaluate the effect of dopamine withdrawal on serum concentrations of DHEAS, PRL and cortisol. The median age of the studied patients was 37 years (range 18–83 years) MEASUREMENTS Serum DHEAS and cortisol concentrations were measured by RIA and PRL by IRMA. The assessed serum samples were obtained at 0300h on each of two consecutive study nights. RESULTS Withdrawal of dopamine infusion was found to elicit a median 25% Increase of serum DHEAS concentrations within 24 hours whereas no significant change in DHEAS levels was observed when dopamine infusion was continued throughout both study nights ( P = 0.01 continued vs interrupted dopamine). Prolactin levels were undetectable as long as dopamine was infused, and increased to a median of 317 IU/I after 24 hours of dopamine withdrawal ( P = 0.0007). Elevated serum cortisol levels remained comparable with continued and interrupted dopamine infusion. CONCLUSIONS Dopamine infusion appears to suppress serum DHEAS concentrations in critically ill patients without affecting their elevated serum cortisol levels, suggesting a differential regulation of DHEAS and cortisol metabolism in critical illness. The lowering effect of dopamine on DHEAS levels could be linked to the concomitant suppression of circulating PRL. The simultaneous suppression of circulating PRL and DHEAS by dopamine infusion may be an iatrogenic factor maintaining or aggravating the anergic state of prolonged severe illness.