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cortisol in septic shock

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https://www.readbyqxmd.com/read/27798546/evaluation-of-early-corticosteroid-therapy-in-management-of-pediatric-septic-shock-in-pediatric-intensive-care-patients-a-randomized-clinical-study
#1
Ahmed El-Nawawy, Doaa Khater, Heba Omar, Yasser Wali
BACKGROUND: Septic shock is a major healthcare problem. Adrenal insufficiency in children with septic shock is a recognized complication, yet is controversial regarding its management and effect on mortality. According to the current guidelines, children with risk factors for adrenal insufficiency should receive a stress dose of steroids in step 3 of treatment. This study aimed to evaluate and compare early corticosteroid therapy with the traditional use of steroids among pediatric septic shock patients...
October 25, 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27751222/-changes-in-serum-cortisol-and-adrenocorticotropic-hormone-in-children-with-sepsis-shock-and-their-clinical-significance
#2
Hai Lin, Zi-Jing Wang, Shi-Biao Wang, Yu-Lan Kang
OBJECTIVE: To study the changes in serum levels of cortisol and adrenocorticotropic hormone (ACTH) in children with septic shock (SS) and to explore their relationship with the disease severity and prognosis. METHODS: Twenty-five children with decompensated SS and 24 children with early SS were enrolled. Serum cortisol and ACTH levels were determined on admission and days 3 and 8 after admission. Twenty-five healthy children were used as the control group. The children with decompensated SS were further divided into death group (n=5) and survival group (n=20) based on their clinical outcome...
October 2016: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
https://www.readbyqxmd.com/read/27465754/prognostic-value-of-relative-adrenal-insufficiency-during-cardiogenic-shock-a-prospective-cohort-study-with-long-term-follow-up
#3
François Bagate, Nicolas Lellouche, Pascal Lim, Stephane Moutereau, Keyvan Razazi, Guillaume Carteaux, Nicolas de Prost, Jean-Luc Dubois-Randé, Christian Brun-Buisson, Armand Mekontso Dessap
BACKGROUND: Relative adrenal insufficiency (RAI) is common in ICU patients, particularly during septic shock (SS). Cardiogenic shock (CS) may share some pathophysiological features with SS. The aim of this study was to evaluate the prevalence and long-term prognosis of RAI during CS. METHODS: Prospective observational study conducted in the intensive care and cardiology units in one university hospital in France. Patients meeting the criteria for CS without prior corticosteroid therapy were included...
July 25, 2016: Shock
https://www.readbyqxmd.com/read/27379022/the-role-of-acth-and-corticosteroids-for-sepsis-and-septic-shock-an-update
#4
REVIEW
Djillali Annane
Sepsis is a common disorder associated with high morbidity and mortality. It is now defined as an abnormal host response to infection, resulting in life-threatening dysfunction of organs. There is evidence from in vitro and in vivo experiments in various animal models and in patients that endotoxin or sepsis may directly and indirectly alter the hypothalamic-pituitary-adrenal response to severe infection. These alterations may include necrosis or hemorrhage or inflammatory mediator-mediated decreased ACTH synthesis, steroidogenesis, cortisol delivery to tissues, clearance from plasma, and decreased sensitivity of tissues to cortisol...
2016: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/27363046/endocrine-and-metabolic-alterations-may-underlie-mortality-of-severe-sepsis-and-septic-shock-patients-admitted-to-icu
#5
Abdelbadee Ameen, Marwa Abdel Rehim, Yasser Hassan Shaaban
The study evaluated endocrinal and metabolic response to sepsis and its applicability for the prediction of outcome of septic patients. Patients were 39 adult with severe infections and within 24 h after onset or suspected clinical tissue hypoperfusion. At enrollment patients were evaluated for acute physiology and chronic health evaluation II score (APACHE II) and Glasgow Coma Scale (GCS). Global hemodynamic parameters including systolic blood pressure (SBP), heart rate (HR) and central venous pressure (CVP) were recorded and monitored...
April 2016: Journal of the Egyptian Society of Parasitology
https://www.readbyqxmd.com/read/27153324/systemic-inflammation-methodological-approaches-to-identification-of-the-common-pathological-process
#6
N V Zotova, V A Chereshnev, E Yu Gusev
We defined Systemic inflammation (SI) as a "typical, multi-syndrome, phase-specific pathological process, developing from systemic damage and characterized by the total inflammatory reactivity of endotheliocytes, plasma and blood cell factors, connective tissue and, at the final stage, by microcirculatory disorders in vital organs and tissues." The goal of the work: to determine methodological approaches and particular methodical solutions for the problem of identification of SI as a common pathological process...
2016: PloS One
https://www.readbyqxmd.com/read/26537554/term-neonates-with-infection-and-shock-display-high-cortisol-precursors-despite-low-levels-of-normal-cortisol
#7
Abdelmoneim Khashana, Marja Ojaniemi, Markku Leskinen, Timo Saarela, Mikko Hallman
AIM: Neonatal therapy-resistant septic shock is a common problem in middle and low-income countries. We investigated whether newborn infants with infection and therapy-resistant hypotension showed evidence of abnormal levels of cortisol or cortisol precursors. METHODS: A total of 60 term or near term neonates with evidence of infection were enrolled after informed consent. Of these, 30 had an infection and refractory shock and 30 had an infection without shock. There were no detectable differences between the groups in the length of gestation, birth weight or gender distribution...
February 2016: Acta Paediatrica
https://www.readbyqxmd.com/read/26130795/evidence-of-subcutaneous-tissue-lipolysis-enhancement-by-endogenous-cortisol-in-critically-ill-patients-without-shock
#8
Ioannis Ilias, Marinella Tzanela, Nikitas Nikitas, Dimitra A Vassiliadi, Maria Theodorakopoulou, Sofia Apollonatou, Stylianos Tsagarakis, Ioanna Dimopoulou
BACKGROUND/AIM: Cortisol is involved in in many aspects of adipose tissue metabolism. A positive association between plasma cortisol and lipolysis has been observed. Critically ill patients exhibit 'lipemia of sepsis'. The aim of the present study was to study, in septic ICU patients, adipose tissue lipolysis in relation to tissue cortisol using microdialysis (MD). PATIENTS AND METHODS: We studied 17 mechanically-ventilated patients (9 men; mean±SD age=63±19 years) with a diagnosis of severe sepsis...
July 2015: In Vivo
https://www.readbyqxmd.com/read/25942482/effect-of-early-parenteral-nutrition-on-the-hpa-axis-and-on-treatment-with-corticosteroids-in-intensive-care-patients
#9
RANDOMIZED CONTROLLED TRIAL
Philippe Meersseman, Eva Boonen, Bram Peeters, Sarah Vander Perre, Pieter J Wouters, Lies Langouche, Greet Van den Berghe
BACKGROUND: Nutrition can affect the hypothalamus-pituitary-adrenal axis. We hypothesized that early administration of parenteral nutrition (PN) during critical illness reduces plasma ACTH and cortisol concentrations and thereby increases the use of corticosteroids. METHODS: This is a preplanned substudy of a randomized controlled trial (EPaNIC) that compared early PN with late PN in 4640 critically ill patients. We investigated the effect of early vs late PN on any steroid treatment and on treatment for ≥ 5 days to capture patients with clinical suspicion of adrenal insufficiency, and assessed whether this was related to an effect on septic shock...
July 2015: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/25763364/endocrine-dysfunction-in-sepsis-a-beneficial-or-deleterious-host-response
#10
REVIEW
Valeriu Gheorghiţă, Alina Elena Barbu, Monica Livia Gheorghiu, Florin Alexandru Căruntu
Sepsis is a systemic, deleterious inflammatory host response triggered by an infective agent leading to severe sepsis, septic shock and multi-organ failure. The host response to infection involves a complex, organized and coherent interaction between immune, autonomic, neuroendocrine and behavioral systems. Recent data have confirmed that disturbances of the autonomic nervous and neuroendocrine systems could contribute to sepsis-induced organ dysfunction. Through this review, we aimed to summarize the current knowledge about the endocrine dysfunction as response to sepsis, specifically addressed to vasopressin, copeptin, cortisol, insulin and leptin...
March 2015: Germs
https://www.readbyqxmd.com/read/25636722/the-half-lives-of-intact-and-elastase-cleaved-human-corticosteroid-binding-globulin-cbg-are-identical-in-the-rabbit
#11
John G Lewis, Katie Saunders, Arron Dyer, Peter A Elder
Corticosteroid-binding globulin (CBG) is a non-inhibitory member of the serpin superfamily of serine protease inhibitors and carries the majority of cortisol in circulation. It can be cleaved by neutrophil elastase at its exposed reactive centre loop which decreases its affinity for cortisol allowing the release of most of the cortisol at sites of inflammation. Intact and elastase cleaved CBG can be distinguished from each other and can coexist in circulation but with unknown half-lives. Here we treated a portion of purified human CBG with elastase, terminated the digestion and then combined this portion with intact human CBG and measured their respective half-lives in rabbits by ELISA...
May 2015: Journal of Steroid Biochemistry and Molecular Biology
https://www.readbyqxmd.com/read/25543020/the-role-of-adrenal-gland-microenvironment-in-the-hpa-axis-function-and-dysfunction-during-sepsis
#12
REVIEW
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
https://www.readbyqxmd.com/read/25410037/bilateral-adrenal-haemorrhagic-infarction-in-a-patient-with-antiphospholipid-syndrome
#13
Rebecca Louise Godfrey, James Clark, Benjamin Field
A 68-year-old woman with antiphospholipid syndrome presented with a 3-day history of bilateral loin pain, vomiting, fever and confusion. On examination she was febrile, hypotensive and tachycardic. Investigations revealed raised inflammatory markers, renal impairment and hyponatraemia. Abdominal ultrasound revealed two well-defined heterogeneous areas bilaterally in the region of the adrenal glands. This prompted serum cortisol measurement and a CT of the abdomen. Cortisol was low in the context of sepsis at 48 nmol/L, and CT confirmed bilateral heterogeneous adrenal pathology...
November 19, 2014: BMJ Case Reports
https://www.readbyqxmd.com/read/25409953/depletion-of-high-affinity-corticosteroid-binding-globulin-corresponds-to-illness-severity-in-sepsis-and-septic-shock-clinical-implications
#14
M A Nenke, W Rankin, M J Chapman, N E Stevens, K R Diener, J D Hayball, J G Lewis, D J Torpy
OBJECTIVE: Corticosteroid-binding globulin (CBG) is cleaved by neutrophil elastase converting the high-affinity (haCBG) conformation of CBG to a low-affinity (laCBG) conformation with a ninefold reduced cortisol-binding affinity. These in vitro data suggest that cortisol release by CBG cleavage results in the targeted delivery of cortisol to areas of inflammation. Our objective was to determine whether CBG cleavage alters circulating levels of haCBG and laCBG in vivo in proportion to sepsis severity...
June 2015: Clinical Endocrinology
https://www.readbyqxmd.com/read/25365720/reversible-increase-in-maximal-cortisol-secretion-rate-in-septic-shock
#15
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
https://www.readbyqxmd.com/read/25310332/adrenal-insufficiency-in-sepsis
#16
Andrea Polito, Jérôme Aboab, Djillali Annane
BACKGROUND AND OBJECTIVES: Corticosteroids were introduced in the treatment of severe infection as early as in the nineteen forties. Several " negative" randomized controlled trials of high-dose of glucocorticoids given for a short period of time in the early course of severe sepsis or acute respiratory distress syndrome raised serious doubts on the benefit of this treatment. Recently, a link between septic shock and adrenal insufficiency, or systemic inflammation induced glucocorticoids receptor resistance had been established...
March 2006: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25306943/-relative-adrenal-insufficiency-in-septic-shock-comparison-of-the-response-to-hydrocortisone-in-patients-diagnosed-through-random-cortisol-measurement-versus-corticotropin-test
#17
José Raimundo A de Azevedo, Renato Palácio de Azevedo, Rachel Jorge D Cossetti, Eduardo Rodrigues M Lima, Gescirene Borges de Sousa
BACKGROUND AND OBJECTIVES: The incidence of relative adrenal insufficiency (RAI) in patients with septic shock is high and has a significant impact on survival. The purpose of this study was to determine whether a random cortisol concentration < 25 mg/dL was as good as a low dose (1 mg) corticotrophin stimulation test in the diagnosis of RAI in patients with septic shock as assessed by the hemodynamic response to hydrocortisone. METHODS: Patients were randomized to a single cortisol determination or to a low dose corticotrophin stimulation test...
March 2008: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25294215/hypothalamic-pituitary-adrenal-axis-in-lethal-canine-staphylococcus-aureus-pneumonia
#18
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
https://www.readbyqxmd.com/read/25243181/early-response-roles-for-prolactin-cortisol-and-circulating-and-cellular-levels-of-heat-shock-proteins-72-and-90%C3%AE-in-severe-sepsis-and-sirs
#19
K Vardas, K Apostolou, E Briassouli, D Goukos, K Psarra, E Botoula, S Tsagarakis, E Magira, C Routsi, S Nanas, G Briassoulis
OBJECTIVE: To evaluate the early heat shock protein (HSP) and hormonal stress response of intensive care unit (ICU) patients with severe sepsis/septic shock (SS) or systemic inflammatory response syndrome (SIRS) compared to healthy subjects (H). METHODS: Patients with early (first 48 hrs) SS (n = 29) or SIRS (n = 29) admitted to a university ICU and 16 H were enrolled in the study. Serum prolactin, cortisol, and plasma ACTH were determined using immunoassay analyzers...
2014: BioMed Research International
https://www.readbyqxmd.com/read/25223852/prognostic-significance-of-hypothalamic-pituitary-adrenal-axis-hormones-in-early-sepsis-a-study-performed-in-the-emergency-department
#20
Qian Zhang, Guijuan Dong, Xin Zhao, Miaomiao Wang, Chun-Sheng Li
PURPOSE: The response of the hypothalamic-pituitary-adrenal (HPA) axis to the sustained stress of sepsis has been the focus of study in recent years because the early phase of sepsis is known to be dominated by major alterations in the HPA axis. This prospective observational study aimed at assessing the predictive values of copeptin and HPA hormones in determining sepsis progression and mortality in the emergency department (ED). METHODS: Serum arginine vasopressin (AVP) and copeptin concentrations were measured upon ED admission...
October 2014: Intensive Care Medicine
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