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from 3.7 - ENDOCRINE SYSTEM IN CARDIOTHORACIC CRITICAL CARE
Published online by Cambridge University Press: 05 July 2014
Introduction
‘The constancy of the internal environment is the condition that life should be free and independent. … So far from the higher animal being indifferent to the external world, it is on the contrary in a precise and informed relation with it, in such a way that its equilibrium results from a continuous and delicate compensation, established as by the most sensitive of balances.’
– Claude Bernard 1813-1878The ‘internal milieu’ is a complex system influenced and controlled by the combined effects of the endocrine, nervous and immune systems. The actions of these systems are further complicated by their differing responses to acute and chronic stressors, features that are readily identifiable in the post cardiac surgical patient. At the time of writing, the catalog of hormones recognized as active in the maintenance of this human equilibrium consists of 55 compounds, and doubtless the number will continue to grow.
The state of knowledge in relation to these issues is advancing day by day, and management strategies of patients in the cardiac surgical critical care area are similarly in a state of flux; we are indeed in the era of ‘known knowns, known unknowns and unknown unknowns.’
The pituitary
Chronic pituitary insufficiency
Common causes of chronic pituitary insufficiency include pituitary adenomas (the most common), inflammatory destruction, surgical removal, radiation-induced destruction of pituitary tissue, subarachnoid hemorrhage and postpartum pituitary necrosis (Sheehan syndrome).
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