Asko Riutta1, Pauli Ylitalo, Seppo Kaukinen. 1. Department of Pharmacological Sciences, Medical School, University of Tampere, 33014, Tampere, Finland. asko.riutta@uta.fi
Abstract
OBJECTIVE: To study the diurnal variation of melatonin and cortisol in critically ill patients and to assess whether the severity of organ dysfunction, sedation and sympathetic activity correlate with the production of these hormones. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: Forty non-septic patients without brain injury and treatment with adrenergic agonists or corticosteroids. Twenty-five of the patients were sedated with benzodiazepines. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The pattern of melatonin production was monitored by the determination of 6-sulphatoxymelatonin (aMT6s) in urine. The 12-h aMT6s excretions at nights (11.8 +/- 8.9 microg, mean +/- SD) were higher than in the daytime (6.8 +/- 7.5 microg; P < 0.0001), and benzodiazepine treatment did not abolish the diurnal periodicity of aMT6s excretion during the entire 3-day study period. Serum cortisol concentrations at noon (524 +/- 276 nmol/l, mean +/- SD) were higher than at midnight (415 +/- 172 nmol/l; P < 0.0001), and the decrease at midnight was significant also in the patients treated with benzodiazepines. Sympathetic activity was monitored with urine vanillylmandelic acid (VMA). The 12-h VMA excretions did not show a diurnal variation, but a significant positive relationship between the 12-h VMA and aMT6s excretions was observed. The severity of organ dysfunction did not correlate either with the aMT6s and VMA excretion or with serum cortisol concentration. CONCLUSIONS: The diurnal variation of melatonin and cortisol is maintained in non-septic intensive care unit patients. Benzodiazepines do not impair the diurnal variation of melatonin and cortisol.
OBJECTIVE: To study the diurnal variation of melatonin and cortisol in critically illpatients and to assess whether the severity of organ dysfunction, sedation and sympathetic activity correlate with the production of these hormones. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit in a university hospital. PATIENTS: Forty non-septic patients without brain injury and treatment with adrenergic agonists or corticosteroids. Twenty-five of the patients were sedated with benzodiazepines. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The pattern of melatonin production was monitored by the determination of 6-sulphatoxymelatonin (aMT6s) in urine. The 12-h aMT6s excretions at nights (11.8 +/- 8.9 microg, mean +/- SD) were higher than in the daytime (6.8 +/- 7.5 microg; P < 0.0001), and benzodiazepine treatment did not abolish the diurnal periodicity of aMT6s excretion during the entire 3-day study period. Serum cortisol concentrations at noon (524 +/- 276 nmol/l, mean +/- SD) were higher than at midnight (415 +/- 172 nmol/l; P < 0.0001), and the decrease at midnight was significant also in the patients treated with benzodiazepines. Sympathetic activity was monitored with urine vanillylmandelic acid (VMA). The 12-h VMA excretions did not show a diurnal variation, but a significant positive relationship between the 12-h VMA and aMT6s excretions was observed. The severity of organ dysfunction did not correlate either with the aMT6s and VMA excretion or with serum cortisol concentration. CONCLUSIONS: The diurnal variation of melatonin and cortisol is maintained in non-septic intensive care unit patients. Benzodiazepines do not impair the diurnal variation of melatonin and cortisol.
Authors: Daliana Peres Bota; Christian Melot; Flavio Lopes Ferreira; Vinh Nguyen Ba; Jean-Louis Vincent Journal: Intensive Care Med Date: 2002-09-06 Impact factor: 17.440
Authors: G Hajak; A Rodenbeck; H D Ehrenthal; S Leonard; D Wedekind; G Sengos; D Zhou; G Huether Journal: Psychopharmacology (Berl) Date: 1997-10 Impact factor: 4.530
Authors: S R Bornstein; J Licinio; R Tauchnitz; L Engelmann; A B Negrão; P Gold; G P Chrousos Journal: J Clin Endocrinol Metab Date: 1998-01 Impact factor: 5.958
Authors: Alina Gavrila; C-K Peng; Jean L Chan; Joseph E Mietus; Ary L Goldberger; Christos S Mantzoros Journal: J Clin Endocrinol Metab Date: 2003-06 Impact factor: 5.958
Authors: Matthew B Maas; Bryan D Lizza; Sabra M Abbott; Eric M Liotta; Maged Gendy; John Eed; Andrew M Naidech; Kathryn J Reid; Phyllis C Zee Journal: Crit Care Med Date: 2020-06 Impact factor: 7.598
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Jerôme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2010-01-08 Impact factor: 17.440
Authors: Jennifer Foster; Lisa D Burry; Lehana Thabane; Karen Choong; Kusum Menon; Mark Duffett; Alexandra Cheung; Melanie Guenette; Timothy Chimunda; Louise Rose Journal: Syst Rev Date: 2016-11-24
Authors: Stefan Pilz; Michael Krebs; Walter Bonfig; Wolfgang Högler; Anna Hochgerner; Greisa Vila; Christian Trummer; Verena Theiler-Schwetz; Barbara Obermayer-Pietsch; Peter Wolf; Thomas Scherer; Florian Kiefer; Elke Fröhlich-Reiterer; Elena Gottardi-Butturini; Klaus Kapelari; Stefan Schatzl; Susanne Kaser; Günter Höfle; Dietmar Schiller; Vinzenz Stepan; Anton Luger; Stefan Riedl Journal: J Klin Endokrinol Stoffwechs Date: 2022-03-02