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adrenal dysfunction in critical ill patients

Bram Peeters, Lies Langouche, Greet Van den Berghe
Critically ill patients have elevated plasma cortisol concentrations, in proportion to illness severity. This was traditionally attributed exclusively to a central activation of the hypothalamus-pituitary axis. However, low rather than high plasma ACTH concentrations have been reported in critically ill patients, with loss of diurnal ACTH and cortisol rhythm. Low ACTH together with high cortisol is referred to as "ACTH-cortisol dissociation." Although cortisol production is somewhat increased with inflammation, a reduced cortisol breakdown explains to a larger extent the hypercortisolism during critical illness...
December 12, 2017: Comprehensive Physiology
Brian E Leonard
This review summarises the evidence that chronic low grade inflammation triggers changes that contribute to the mental and physical ill health of patients with major depression. Inflammation, and the activation of the hypothalamic pituitary axis by stress, are normal components of the stress response but when stress is prolonged and the endocrine and immune system become chronic resulting in the activation of the peripheral macrophages, the central microglia and hypercortisolemia, the neuronal networks are damaged and become dysfunctional...
February 2018: Acta Neuropsychiatrica
Hans D Katzberg, Charles D Kassardjian
PURPOSE OF REVIEW: This article discusses the clinical features, pathophysiology, and management of toxic and endocrine myopathies. RECENT FINDINGS: Early detection and expeditious correction of metabolic disturbances in endocrinopathies such as Cushing syndrome, thyroid and parathyroid diseases, and acromegaly can minimize and prevent neurologic complications including myopathy. Recently proposed mechanisms of injury in patients with critical illness myopathy include inhibition of protein synthesis, mitochondrial dysfunction, disruption of the ubiquitin-proteasome system, oxidative stress, and disruption of intramuscular calcium homeostasis, which can cause a myosin-loss myopathy...
December 2016: Continuum: Lifelong Learning in Neurology
Angelos Halaris
Morbidity and mortality of cardiovascular disease (CVD) is exceedingly high worldwide. Depressive illness is a serious psychiatric illness that afflicts a significant portion of the world population. Epidemiological studies have confirmed the high co-morbidity between these two disease entities. The co-morbidity is bidirectional and the mechanisms responsible for it are complex and multifaceted. In addition to genetic, biological systems, psychosocial, and behavioral factors that are involved include the central and autonomic nervous systems, the neuroendocrine, immune, and the vascular and hematologic systems...
2017: Current Topics in Behavioral Neurosciences
Francisco Valenzuela-Sánchez, Blanca Valenzuela-Méndez, Juan Francisco Rodríguez-Gutiérrez, Ángel Estella-García, María Ángela González-García
Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator...
September 2016: Annals of Translational Medicine
Gary Xia Vern Tan, Tom Sutherland
INTRODUCTION: Adrenal hemorrhage is an uncommon but potentially life-threatening condition, particularly in cases of bilateral adrenal hemorrhage causing primary adrenal insufficiency. It is difficult to diagnose clinically, particularly in critically ill patients, given its non-specific symptoms and signs, which include abdominal pain, vomiting, fever, weakness, hypotension, and altered conscious state. Non-traumatic adrenal hemorrhage has been observed to occur in times of physiological stress, such as post-surgery, sepsis, burns, and hypotension...
February 2016: Abdominal Radiology
Prerana Shrestha, Awni Mousa, Nathaniel Heintz
Major depressive disorder (MDD) is a prevalent illness that can be precipitated by acute or chronic stress. Studies of patients with Wolfram syndrome and carriers have identified Wfs1 mutations as causative for MDD. The medial prefrontal cortex (mPFC) is known to be involved in depression and behavioral resilience, although the cell types and circuits in the mPFC that moderate depressive behaviors in response to stress have not been determined. Here, we report that deletion of Wfs1 from layer 2/3 pyramidal cells impairs the ability of the mPFC to suppress stress-induced depressive behaviors, and results in hyperactivation of the hypothalamic-pituitary-adrenal axis and altered accumulation of important growth and neurotrophic factors...
September 15, 2015: ELife
Vincenzo De Sanctis, Ashraf Soliman, Mohamed Yassin, Piernicola Garofalo
Evaluating children or adolescents with central adrenal insufficiency (CAI) is a difficult task in clinical practice, especially in subjects with hypothalamic-pituitary diseases and partial ACTH deficiency, or in those with recent pituitary surgery or brain irradiation when the adrenal cortex may still be responsive to stress. In 2008, a meta-analysis reported a three-step approach for evaluating patients at risk for CAI with no acute illness. In particular, the authors recommended the evaluation of morning cortisol, a low dose ACTH test (LDST) and the "gold standard" insulin tolerance test or metyrapone test if the low LDCT was not diagnostic...
March 2015: Pediatric Endocrinology Reviews: PER
Eric A Bruder, Ian M Ball, Stacy Ridi, William Pickett, Corinne Hohl
BACKGROUND: The use of etomidate for emergency airway interventions in critically ill patients is very common. In one large registry trial, etomidate was the most commonly used agent for this indication. Etomidate is known to suppress adrenal gland function, but it remains unclear whether or not this adrenal gland dysfunction affects mortality. OBJECTIVES: The primary objective was to assess, in populations of critically ill patients, whether a single induction dose of etomidate for emergency airway intervention affects mortality...
January 8, 2015: Cochrane Database of Systematic Reviews
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
Balasubramanian Venkatesh, Jeremy Cohen
OBJECTIVE: One of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review was to examine the evidence base underlying the corticotropin test in the management of the critically ill patient. DATA SYNTHESIS: The principle behind the corticotropin test is the demonstration of an inappropriately low cortisol production in response to exogenous ACTH, a situation analogous to physiological stress...
September 2015: Clinical Endocrinology
Jamie M Burkitt Creedon
OBJECTIVES: To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. ETIOLOGY: Critical illness-related corticosteroid insufficiency may be due to hypothalamic-pituitary-adrenal (HPA) axis dysfunction, alterations in cortisol-plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness...
January 2015: Journal of Veterinary Emergency and Critical Care
Urmil Pandya, Nathan Polite, Teresa Wood, Michael Lieber
Dysfunction in the hypothalamopituitary adrenal axis is thought to exist; however, there continues to be controversy about what level of serum cortisol corresponds to adrenal insufficiency. Few studies have focused on the significance of serum random cortisol in the critically ill trauma patient. Trauma patients with total serum random cortisol levels drawn in the intensive care unit within the first seven days of hospitalization were retrospectively reviewed. The primary outcome measured was in-hospital mortality...
November 2014: American Surgeon
Ahad Eshraghian, Seyed Alireza Taghavi
BACKGROUND: Cirrhosis is the end stage of many different forms of acute and chronic liver damages. Interactions between liver and endocrine system is significant, because liver is the main organ of metabolism and catabolism of many proteins. AIM: In this study, current literature about endocrine abnormalities among patients with liver cirrhosis was reviewed. METHODS: A PubMed search was performed on English literature from January 1990 onward to find human studies reporting endocrine dysfunction in liver cirrhosis...
October 2014: Archives of Iranian Medicine
Angelos Halaris
Morbidity and mortality of cardiovascular disease is exceedingly high worldwide. Depressive illness is a serious psychiatric illness that afflicts a significant portion of the population worldwide. Epidemiological studies have confirmed the high co-morbidity between these two entities and the co-morbidity is bidirectional. Systems that are involved in and accountable for this co-morbidity in a major, complex and interactive way include the central and autonomic nervous systems, the neuroendocrine system, the immune system, and the vascular and hematologic systems...
2013: Modern Trends in Pharmacopsychiatry
Yi-Min Zhu, Fang Liu, Xiao-Yu Zhou, Xi-Rong Gao, Zhi-Yue Xu, Yu-Kai Du
BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis. METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children's Hospital, China from 2003 to 2009, and died of multiple organ failure...
2011: World Journal of Emergency Medicine
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
Christos K Triantos, Maria Kalafateli, Dimitrios Samonakis, Konstantinos Zisimopoulos, Nikolaos Papiamonis, Apostolos Sapountzis, Marina Michalaki, Georgios Theocharis, Konstantinos Thomopoulos, Chryssoula Labropoulou-Karatza, Venetsanea Kyriazopoulou, Eleni Jelastopulu, Elias A Kouroumalis, Vasiliki Nikolopoulou, Andrew K Burroughs
BACKGROUND AND AIMS: Critical illness-related corticosteroid insufficiency has been reported in acute variceal bleeding (AVB). In cirrhosis, free serum cortisol (FC) is considered optimal to assess adrenal function. Salivary cortisol (SC) is considered a surrogate for FC. We evaluated FC and its prognostic role in AVB. METHODS: Total serum cortisol, SC, cortisol-binding globulin, and FC (Coolens' formula) were evaluated in AVB (n=38) and in stable cirrhosis (CC) (n=31)...
October 2014: European Journal of Gastroenterology & Hepatology
G Karagüzel, E Cakir
Cortisol is the major glucocorticoid synthesized by the adrenal cortex and its secretion is under the control of hypothalamic-pituitary axis. There is an increase in corticotrophin-releasing hormone and corticotrophin secretion and a decrease in the negative-feedback effect during critical illness. Adrenal insufficiency (AI) in children with critical illness is defined as an inadequate glucocorticoid response, measured by the peak cortisol or the increment in the cortisol level following exogenous ACTH (corticotrophin) administration...
December 2014: Minerva Endocrinologica
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