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Adrenal function and sepsis

Waldemar Kanczkowski, Mariko Sue, Stefan R Bornstein
Survival of all living organisms depends on maintenance of a steady state of homeostasis, which process relies on its ability to react and adapt to various physical and emotional threats. The defense against stress is executed by the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal medullary system. Adrenal gland is a major effector organ of stress system. During stress, adrenal gland rapidly responds with increased secretion of glucocorticoids (GCs) and catecholamines into circulation, which hormones, in turn, affect metabolism, to provide acutely energy, vasculature to increase blood pressure, and the immune system to prevent it from extensive activation...
2016: Frontiers in Endocrinology
Maria Helena Palma Sircili, Tania Sartori Sanchez Bachega, Guiomar Madureira, Larissa Gomes, Berenice Bilharinho Mendonca, Francisco Tibor Dénes
PURPOSE: Genital reconstruction in female patients with virilizing congenital adrenal hyperplasia (CAH) is very challenging. Our aim was to evaluate the techniques employed to treat complications after failure of primary urogenital sinus (UGS) surgery, as well as the result of these reoperations. PATIENTS AND METHODS: Twenty girls with virilizing CAH who were previously submitted to genitoplasty in our service and elsewhere had recurrent UGS stenosis and vaginal introitus stenosis that required surgical treatment...
2016: Frontiers in Pediatrics
Caroline Cole
CASE SUMMARY: A 6 yr old 45 kg child with severe Cushinoid features was admitted to PICU with probable hypertensive encephalopathy. She presented with increasing headaches, vomiting and seizures becoming unresponsive with a GCS of 3. She was profoundly hypertensive and her cortisol levels were significantly elevated (>2000 nmol/L). Rapid reduction in cortisol levels was required to stabilise her condition prior to surgery. Etomidate is the only readily available intravenous preparation which reliably suppresses adrenocortical function...
September 2016: Archives of Disease in Childhood
Na Liu, Yu Zhang, Jun-Yu Xiong, Shan Liu, Jie Zhu, Shen Lv
BACKGROUND: Both hyperinflammation during sepsis and etomidate can suppress adrenal function. In this study, we explored whether treatment with pituitary adenylate cyclase-activating polypeptide (PACAP) relieves adrenal suppression in cecal ligation and puncture (CLP)-induced septic rats. MATERIALS AND METHODS: Female Sprague-Dawley rats were randomly divided into five groups (n=7 per group), including the sham group, sepsis group (CLP group), sepsis and etomidate group (CLP+ETO group), PACAP group, and etomidate alone group (ETO group)...
August 2016: Neuropeptides
Kazumasa Emori, Nobuhiro Takeuchi, Junichi Soneda
A 50-year-old male was brought to our emergency department by ambulance with complaints of pain and numbness in both legs. At arrival, purple spots were evident on his neck and face. Examination of the vital sign indicated septic shock. Laboratory data and blood gas analysis revealed disseminated intravascular coagulation, multiple organ failure, and metabolic acidosis. Peripheral blood smears revealed Howell-Jolly bodies, indicating decreased splenic function. A rapid urinary pneumococcal antigen test was also found to be positive...
2016: Case Reports in Critical Care
Salvatore Andrea Mastrolia, Offer Erez, Giuseppe Loverro, Edoardo Di Naro, Adi Yehuda Weintraub, Dan Tirosh, Joel Baron, Reli Hershkovitz
Preterm parturition is a syndrome that may result from many underlying mechanisms. Infection and inflammation are the prominent ones. Intrauterine infection and inflammation have an effect akin to sepsis, and that is similar to systemic inflammatory response in adults. Indeed, there is evidence to support the association of a fetal inflammatory response syndrome (FIRS) to systemic infection and inflammation. The utilization of invasive procedures for the prenatal diagnosis of FIRS is associated with a risk for complications resulting from the invasive method...
July 2016: American Journal of Obstetrics and Gynecology
Carla Jennewein, Nguyen Tran, Waldemar Kanczkowski, Lars Heerdegen, Ajith Kantharajah, Stefan Dröse, Stefan Bornstein, Bertram Scheller, Kai Zacharowski
OBJECTIVES: Sepsis and septic shock are commonly present in the ICU and accompanied by significant morbidity, mortality, and cost. The frequency of secondary adrenal insufficiency in sepsis remains open to debate and a challenge to identify and treat appropriately. Animal models of sepsis using genetic or surgical initiation of adrenal insufficiency resulted in increased mortality, but the mechanisms are still unclear. The present study investigates the impact of adrenal inflammation in septic mice challenged with cecal ligation and puncture...
April 2016: Critical Care Medicine
Junting Ai, Ling Guo, Zhong Zheng, Shu-Xia Wang, Bing Huang, Xiang-An Li
OBJECTIVES: Corticosteroid therapy is frequently used in septic patients given the rationale that there is an increased demand for corticosteroid in sepsis, and up to 60% of severe septic patients experience adrenal insufficiency. However, the efficacy of corticosteroid therapy and whether the therapy should be based on the results of adrenal function testing are highly controversial. The lack of an adrenal insufficiency animal model and our poor understanding of the pathogenesis caused by adrenal insufficiency present significant barriers to address this long-standing clinical issue...
November 2015: Critical Care Medicine
Yukiko Hata, Takashi Chiba, Maki Ohtani, Shin Ishizawa, Naoki Nishida
We report an autopsy case of rapid progressive Waterhouse-Friderichsen syndrome (WFS) associated with Streptococcus pneumonia infection in a previously healthy man. Although he once visited a hospital about 6 hours before death, the both physical and serological examination did not show any sign of overwhelming infection. Autopsy showed massive adrenal hemorrhage without inflammation, and showed proliferation of gram positive cocci and microthrombosis in the vessels of many organs. The pathological change of respiratory tract was extremely minimal...
2015: International Journal of Clinical and Experimental Pathology
Kusum Menon, Hector R Wong
OBJECTIVE: To identify the issues needing to be resolved to design, implement, and complete a definitive randomized controlled trial of adjunctive corticosteroid use in children with septic shock. DESIGN: Pediatric studies from MEDLINE (1946 to January 2015) and Embase (1947 to January 2015) that addressed adrenal function or steroid use in critically ill children with systemic inflammatory response syndrome, sepsis, or septic shock were reviewed and their relevant points discussed...
October 2015: Pediatric Critical Care Medicine
Rongqin Ren, John A Cidlowski
As major mediators of stress regulation, glucocorticoids have an essential role in maintaining cardiovascular homeostasis under both physiological and pathological conditions. The release of glucocorticoids into the peripheral circulation is adjusted by the hypothalamic-pituitary-adrenal axis in response to various pathological challenges such as sepsis, starvation, and psychological stress. Clinically, dysregulation of the glucocorticoid-mediated signaling as a result of either excess ligand or receptor hypersensitivity is connected with the progression of unfavorable cardiovascular events such as cardiac hypertrophy, atherosclerosis, and coronary artery disease...
December 1, 2010: Hormone Molecular Biology and Clinical Investigation
Margriet F C de Jong, Nienke Molenaar, Albertus Beishuizen, A B Johan Groeneveld
INTRODUCTION: Adrenal dysfunction may represent critical illness-related corticosteroid insufficiency (CIRCI), as evidenced by a diminished cortisol response to exogenous adrenocorticotropic hormone (ACTH), but this concept and its clinical significance remain highly controversial. We studied the adrenal response to exogenous ACTH as a function of the endogenous cortisol-to-ACTH ratio, a measure of adrenal sensitivity, and of clinical variables, during critical illness and recovery from the acute phase...
2015: Critical Care: the Official Journal of the Critical Care Forum
Waldemar Kanczkowski, Mariko Sue, Kai Zacharowski, Martin Reincke, Stefan R Bornstein
Sepsis and septic shock in response to bacterial or viral infections remain the major health problem worldwide. Despite decades of intensive research and improvements in medical care, severe sepsis is associated with high mortality. Rapid activation of the adrenal gland glucocorticoid and catecholamine production is a fundamental component of the stress response and is essential for survival of the host. However, in many critically ill patients this homeostatic function of the adrenal gland is often impaired...
June 15, 2015: Molecular and Cellular Endocrinology
M K Lukewich, A E Lomax
Sepsis is a severe systemic inflammatory disorder that rapidly activates the sympathetic nervous system to enhance catecholamine secretion from postganglionic sympathetic neurons and adrenal chromaffin cells. Although an increase in preganglionic drive to postganglionic sympathetic tissues has been known to contribute to this response for quite some time, only recently was it determined that sepsis also has direct effects on adrenal chromaffin cell Ca2+ signaling and epinephrine release. In the present study, we characterized the direct effects of sepsis on postganglionic sympathetic neuron function...
January 22, 2015: Neuroscience
Richard I Dorin, Clifford R Qualls, David J Torpy, Ronald M Schrader, Frank K Urban
OBJECTIVE: Cortisol clearance is reduced in sepsis and may contribute to the development of impaired adrenocortical function that is thought to contribute to the pathophysiology of critical illness-related corticosteroid insufficiency. We sought to assess adrenocortical function using computer-assisted numerical modeling methodology to characterize and compare maximal cortisol secretion rate and free cortisol half-life in septic shock, sepsis, and healthy control subjects. DESIGN: Post hoc analysis of previously published total cortisol, free cortisol, corticosteroid-binding globulin, and albumin concentration data...
March 2015: Critical Care Medicine
Irene Cortés-Puch, Caitlin W Hicks, Junfeng Sun, Steven B Solomon, Peter Q Eichacker, Daniel A Sweeney, Lynnette K Nieman, Elizabeth M Whitley, Ellen N Behrend, Charles Natanson, Robert L Danner
The clinical significance and even existence of critical illness-related corticosteroid insufficiency is controversial. Here, hypothalamic-pituitary-adrenal (HPA) function was characterized in severe canine Staphylococcus aureus pneumonia. Animals received antibiotics and titrated life-supportive measures. Treatment with dexamethasone, a glucocorticoid, but not desoxycorticosterone, a mineralocorticoid, improves outcome in this model. Total and free cortisol, adrenocorticotropic hormone (ACTH). and aldosterone levels, as well as responses to exogenous ACTH were measured serially...
December 1, 2014: American Journal of Physiology. Endocrinology and Metabolism
Dimitra Argyro Vassiliadi, Ioanna Dimopoulou, Marinella Tzanela, Evangelia Douka, Olga Livaditi, Stylianos E Orfanos, Anastasia Kotanidou, Stylianos Tsagarakis
CONTEXT: Adrenal dysfunction remains a controversial issue in critical care. The long-stay intensive care unit (ICU) population may be at increased risk of adrenal insufficiency. OBJECTIVE: We aimed to determine whether adrenal dysfunction develops during the course of sepsis. DESIGN: This is a prospective observational longitudinal study. SETTING: The study was conducted in the ICU of a secondary/tertiary care hospital...
December 2014: Journal of Clinical Endocrinology and Metabolism
Yu Zhang, Ruomeng Li, Jie Zhu, Zhaohui Wang, Shen Lv, Jun-Yu Xiong
BACKGROUND: Both hyperinflammation during sepsis and etomidate can suppress adrenal function. In this study, we explored whether pretreatment with etomidate can relieve adrenal suppression and its impact on outcomes of cecal ligation and puncture (CLP)-induced septic rats. MATERIALS AND METHODS: Rats (n = 18 per group) were divided in seven groups, including two control groups and treated with different combinations of a small pretreatment dose (0.6 mg/kg) and a large continuous dose (2 mg/kg/h over 2 h) of etomidate to evaluate the impact of the different administration combinations on the adrenal glands and outcomes in the septic rats...
January 2015: Journal of Surgical Research
Maunank Shah, Caitlin Reed
PURPOSE OF REVIEW: Diagnosis and management of tuberculosis (TB) remains challenging and complex because of the heterogeneity of disease presentations. Despite effective treatment, TB disease can lead to significant short-and long-term health consequences. We review potential acute and chronic complications of TB disease and current management approaches. RECENT FINDINGS: Acute and subacute complications of TB disease are attributable to structural damage or vascular compromise caused by Mycobacterium tuberculosis, as well as metabolic abnormalities and host inflammatory responses...
October 2014: Current Opinion in Infectious Diseases
Sophie Gilibert, Lauriane Galle-Treger, Martine Moreau, Flora Saint-Charles, Sara Costa, Raphaëlle Ballaire, Philippe Couvert, Alain Carrié, Philippe Lesnik, Thierry Huby
Scavenger receptor class B type I (SR-BI)-deficient mice display reduced survival to endotoxic shock and sepsis. The understanding of the mechanisms underlying SR-BI protection has been hampered by the large spectrum of SR-BI functions and ligands. It notably plays an important role in the liver in high-density lipoprotein metabolism, but it is also thought to participate in innate immunity as a pattern recognition receptor for bacterial endotoxins, such as LPS. In this study, we sought to determine the tissue-specific contribution of SR-BI in the hyperinflammatory response and high mortality rates observed in SR-BI(-/-) mice in endotoxicosis or sepsis...
July 15, 2014: Journal of Immunology: Official Journal of the American Association of Immunologists
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