Altered Hormonal Activity in Severely Ill Patients After Injury or Sepsis

Baue, Arthur E.; Günther, B.; Hartl, Wolfgang H.; Ackenheil, Margarethe; Heberer, G.

doi:10.1001/archsurg.1984.01390220011003

Cited by 66 publications

(15 citation statements)

References 57 publications

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“…Patients' diagnoses were evenly distributed among groups. Even though it has been reported that in patients who had severe life-threatening illnesses at the time of death (24,25) or in brain-dead potential organ donors (26,27) serum ACTH and cortisol levels are controversial, ACTH overstimulation in vivo could not be discarded. In a previous study of 3␤-HSD mRNA expression in human adrenal tissues that we have published (4), tissue samples were obtained from similar sources.…”

Section: Discussionmentioning

confidence: 99%

Expression of the IGF System in Human Adrenal Tissues from Early Infancy to Late Puberty: Implications for the Development of Adrenarche

et al. 2005

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Section: Discussionmentioning

confidence: 99%

Expression of the IGF System in Human Adrenal Tissues from Early Infancy to Late Puberty: Implications for the Development of Adrenarche

et al. 2005

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“…Increased plasma levels of catecholamines occur in sepsis, the most common clinical disorder leading to the development of acute lung injury and pulmonary edema (14). Therefore, we hypothesized that the endogenous release of catecholamines in sepsis may stimulate sodium transport and liquid clearance from the distal airspaces of the lung.…”

Section: Introductionmentioning

confidence: 99%

Stimulation of lung epithelial liquid clearance by endogenous release of catecholamines in septic shock in anesthetized rats.

Pittet¹,

Wiener-Kronish²,

McElroy³

et al. 1994

J. Clin. Invest.

196

179

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Exogenous administration of fi-adrenergic agonists has previously been reported to increase lung liquid clearance by stimulation of active sodium transport across the alveolar epithelium. We hypothetized for this study that endogenous release of epinephrine in septic shock would stimulate liquid clearance from the airspaces in rats. Liquid clearance from the air spaces was measured by the concentration of protein over 4 h in a test solution of 5% albumin instilled into one lung. Bacteremic rats developed severe systemic hypotension and metabolic acidosis that was associated with a 100-fold rise in plasma epinephrine levels. There was a 100% increase in liquid clearance from the airspaces of the lung in the bacteremic compared with control rats. To determine the mechanisms responsible for this accelerated lung liquid clearance, amiloride (10'-M), a sodium transport inhibitor, was added to the air spaces. Amiloride prevented the increase in liquid clearance from the airspaces, indicating that this effect depended on increased uptake of sodium across the lung epithelium. The addition of propranolol (10-4 or iO' M) to the instillate also prevented the acceleration in alveolar liquid clearance in the bacteremic rats. We conclude that the release of endogenous catecholamines associated with septic shock markedly stimulates fluid clearance from the distal airspaces of the lung by a 8-adrenergic mediated stimulation of active sodium transport across the epithelial barrier. This data provides evidence for a previously unrecognized mechanism that can protect against or hasten the resolution of alveolar edema in pathological conditions, such as septic shock, that are associated with the endogenous release of catecholamines. (J. Clin. Invest. 1994. 94:663-671.)

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“…CLP induced sepsis caused minimal intestinal histopathologic changes during early period in this study. Yang et al showed marked intestinal histopathologic changes at 21 h after CLP (48,49). We had no signifi cant histopathologic alterations in the intestinal tissues of the rats given replacement therapy or CLP treated.…”

Section: Discussionmentioning

confidence: 46%

Comparison of the therapeutic effects of tri-iodothyronine and methylprednisolone during early sepsis in laboratory animals

Coşkun¹,

Saylam²,

Külah³

et al. 2012

BLL

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Background: Despite major advances, the treatment of sepsis is still a challenging problem for surgeons. This study was aimed to compare the therapeutic effects of methylprednisolone and tri-iodothyronine replacement therapy during an early sepsis. Material and methods: Forty male Wistar albino rats weighing 300-340g were divided into the Control, CLP, CLP/MP, CLP/T3 and CLP/MP/T3 groups. The Control group underwent a sham operation. Only cecal ligation and puncture was performed in the CLP group. The CLP/MP groups received an intramuscular injection of (MP) methylprednisolone (30 mg/kg) at one and half hour before CLP. The CLP/T3 group was given an intraperitoneal (IP) injection of tyroid hormone (T3) 0.4 μg/100 g immediately after CLP. The CLP/MP/T3 group was given IM injection of MP 30 mg/kg before CLP and IP injection of T3 0.4 μg/100 g after CLP. Hemavet changes, blood cultures, peritoneal bacteria content, hormonal alterations and histopathologic changes of intestinal, lung and liver tissue were used to asses the possible therapeutic effects of MP and T3 during early sepsis. Results: A septic insult resulted in signifi cant alterations on hemavet values, free T3, free T4 and cortisol levels, peritoneal bacteria content and intestinal lung and liver tissue samples of the CLP group. Hemavet changes and peritoneal infl ammation fi ndings were signifi cantly limited in the CLP/T3 and CLP/MP/T3 groups. Histopathologic changes had no signifi cant difference between the groups during an early sepsis. Conclusion: Compared to the MP replacement therapy, therapeutic effects of T3 replacement therapy have been found signifi cantly more promising (Tab. 1, Fig. 10, Ref. 49 Despite advances in systemic antibiotics and aggressive surgical intervention, septic shock and multiorgan failure resulting from sepsis continue to be the most common cause of death in surgical intensive care units. Over the past 20 years a large number of clinical trials in septic patients have been performed. In these trials, a variety of therapeutic agents for sepsis have been evaluated, based largely on progress in the understanding of the pathophysiology of sepsis (1-3).The use of corticosteroids has undergone a re-evaluation after the recognition of the adrenal insuffi ciency in septic patients. Recent reports in literature suggest that the treatment of specifi c populations of septic patients with corticosteroid supplementation provide a survival advantage in critically ill patients (4-7).There is also a vast literature on the changes in thyroid function tests that occur during non-thyroidal illness such as sepsis. The changes are defi ned as a decreased concentration of plasma tri-iodotyronine with normal or low thyroxine. Therapy with thyroid hormone as either thyroxine or tri-iodothyronine has been suggested for patients with sepsis, cardiac disease, pulmonary disease or severe infection (8)(9)(10)(11)(12).This study aimed to evaluation and comparison of the effects of methylprednisolone and tri-iodthyronine replacement therapy d...

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Altered Hormonal Activity in Severely Ill Patients After Injury or Sepsis

Cited by 66 publications

References 57 publications

Expression of the IGF System in Human Adrenal Tissues from Early Infancy to Late Puberty: Implications for the Development of Adrenarche

Expression of the IGF System in Human Adrenal Tissues from Early Infancy to Late Puberty: Implications for the Development of Adrenarche

Stimulation of lung epithelial liquid clearance by endogenous release of catecholamines in septic shock in anesthetized rats.

Comparison of the therapeutic effects of tri-iodothyronine and methylprednisolone during early sepsis in laboratory animals

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