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• W2806095026 abstract "In severe sepsis circulating DHEA sulfate (DHEAS) has been shown to decrease whilst serum cortisol increases, suggesting an intraadrenal shift from adrenal androgen towards glucocorticoid synthesis. Patients with sepsis are therefore assumed to be DHEA deficient and subsequently have been suggested to benefit from DHEA replacement. However, only desulfated DHEA is biologically active and recent work has suggested that DHEAS and DHEA may not freely interconvert as previously thought. Therefore, we have studied the relationship between serum cortisol, DHEA and DHEAS at baseline and after ACTH stimulation in 184 patients with severe sepsis (121 men, 63 women) and 78 healthy controls (26 men, 52 women). Measurements were carried out with established radioimmunoassays. As expected, serum DHEAS was significantly lower in healthy women than in men (5.20±0.37 vs. 9.37±0.86µmol/l, p<0.001). However, this difference was less pronounced with regard to baseline DHEA (31.2±2.6 vs. 41.9±4.8 nmol/l, p<0.05) and stimulated DHEA levels did not differ significantly (77.9±5.5 vs. 82.6±5.7 nmol/l, n.s.). Sex-specific differences were conserved in patients with severe sepsis. Serum cortisol was significantly increased in sepsis (1432±90 vs. 370±30 nmol/l, p<0.001) while serum DHEAS was low (f 3.65±0.45 umol/l; m 4.19±0.43 umol/l). However, desulfated DHEA was significantly increased as compared to healthy controls (m 97.7±9.2 vs. 41.9±4.8 nmol/l, p<0.01; f 88.2±10.5 vs. 31.2±2.6 nmol/l, p<0.001) with no further increase after ACTH stimulation in sepsis. This striking discordance between DHEA and DHEAS in sepsis was also documented by significantly increased DHEA/DHEAS ratios (m 45.2±7.2 vs. 4.7±0.4, f 49.2±8.5 vs. 6.8±0.5; all p<0.001). Our results further indicate that DHEAS does not properly reflect the biologically active DHEA pool. Most importantly, we provide evidence for a functional downregulation of DHEA sulfotransferase activity in severe sepsis, resulting in a sharp rise in circulating DHEA, which suggests that there is no need for DHEA replacement in sepsis." @default.
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• W2806095026 date "2005-03-21" @default.
• W2806095026 modified "2023-10-18" @default.
• W2806095026 title "Cortisol, DHEA and DHEAS in severe sepsis – a paradigm revisited" @default.
• W2806095026 doi "https://doi.org/10.1055/s-2005-862816" @default.
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