Mapping the Steroid Response to Major Trauma from Injury to Recovery: A Prospective Cohort Study

Foster, Mark; Hill, Neil; Bentley, Conor; Bishop, Jonathan; Bion, Julian; Fallowfield, Joanne L.; Woods, David R.; Bancos, Irina; Midwinter, Mark; Lord, Janet; Arlt, Wiebke

doi:10.2139/ssrn.3369777

Cited by 5 publications

(11 citation statements)

References 46 publications

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“…However, in contrast to burn injuries, it was not found to exert beneficial effects after major trauma [ 37 ]. On the other hand, sex hormones have the potential to significantly influence the posttraumatic course [ 11 ]. The so-called gender-dependent dimorphism of morbidity and mortality after trauma and sepsis is mainly based on experimental data indicating that sex hormones have relevant effects on various organs and the immune system after trauma and sepsis [ 38 ].…”

Section: Hypothalamic–pituitary–gonadal (Hpg) Axismentioning

confidence: 99%

“…In the clinical setting, DHEA and DHEAS serum levels have been shown to immediately decrease in multiple trauma patients, indicating an early trauma-related reduction of adrenal androgen synthesis [ 11 , 20 ]. In the further clinical course, a stepwise recovery towards pre-traumatic levels over a period of several months was described.…”

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

“…In the further clinical course, a stepwise recovery towards pre-traumatic levels over a period of several months was described. Interestingly, this recovery was significantly influenced by the medication over the clinical course, e.g., with a relevant delay in case of opioid treatment [ 11 ]. The decline of DHEAS was both, more pronounced and permanent compared to DHEA, suggesting an additional downregulation of DHEA sulfation after trauma [ 11 , 108 ].…”

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

“…Interestingly, this recovery was significantly influenced by the medication over the clinical course, e.g., with a relevant delay in case of opioid treatment [ 11 ]. The decline of DHEAS was both, more pronounced and permanent compared to DHEA, suggesting an additional downregulation of DHEA sulfation after trauma [ 11 , 108 ]. As particularly low levels of DHEAS have been associated with an impaired immune function and higher complications rates (e.g., infections, mortality) [ 11 , 109 ], substitution of DHEAS or DHEA with stimulation of its sulfation might represent promising approaches for a beneficial modulation of the posttraumatic course.…”

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

“…Blood levels of the steroid hormone Dehydroepiandrosterone (DHEA) and its sulphated pattern (DHEA-S) are significantly decreased in critically ill and septic patients [ 10 , 11 ]. DHEA is the quantitatively most important human steroid hormone, which is produced mostly in the adrenal gland but also in the gonads.…”

Section: Introductionmentioning

confidence: 99%

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Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome?

Kobbe

Bläsius

Lichte

et al. 2020

JCM

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Although the treatment of multiple-injured patients has been improved during the last decades, sepsis and multiple organ failure (MOF) still remain the major cause of death. Following trauma, profound alterations of a large number of physiological systems can be observed that may potentially contribute to the development of sepsis and MOF. This includes alterations of the neuroendocrine and the immune system. A large number of studies focused on posttraumatic changes of the immune system, but the cause of posttraumatic immune disturbance remains to be established. However, an increasing number of data indicate that the bidirectional interaction between the neuroendocrine and the immune system may be an important mechanism involved in the development of sepsis and MOF. The aim of this article is to highlight the current knowledge of the neuroendocrine modulation of the immune system during trauma and sepsis.

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Section: Hypothalamic–pituitary–gonadal (Hpg) Axismentioning

confidence: 99%

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

Section: Dehydroepiandrosterone (Dhea)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome?

Kobbe

Bläsius

Lichte

et al. 2020

JCM

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Monitoring muscle mass using ultrasound: a key role in critical care

Ruijven

Stapel²,

Molinger

et al. 2021

Current Opinion in Critical Care

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Purpose of reviewThe loss of muscle mass in critically ill patients contributes to morbidity and mortality, and results in impaired recovery of physical functioning. The number of publications on the topic is increasing. However, there is a lack of consistent methodology and the most optimal methodology remains unclear, hampering its broad use in clinical practice. Recent findingsThere is a large variety of studies recently published on the use of ultrasound for assessment of muscle mass. A selection of studies has been made, focusing on monitoring of muscle mass (repeated measurements), practical aspects, feasibility and possible nutrition and physical therapy interventions. In this review, 14 new small (n ¼ 19--121) studies are categorized and reviewed as individual studies.

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The role for long-term use of dehydroepiandrosterone in adrenal insufficiency

Bennett

Cussen

O’Reilly

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewDehydroepiandrosterone (DHEA) is an androgen produced by the zona reticularis of the adrenal gland. Patients with adrenal insufficiency will have a deficiency of DHEA. Unlike glucocorticoid and mineralocorticoid replacement, DHEA supplementation is not considered essential for life and is therefore not routinely replaced in adrenal failure. DHEA deficiency is associated with morbidity, including adverse impacts on metabolic function, quality of life and sexuality in multiple studies. The role for replacement, however, remains unclear.Recent findingsThe benefits of DHEA supplementation have been definitively demonstrated in a number of historical studies of patients with primary and secondary adrenal insufficiency. Beneficial impacts on quality of life, body composition, bone health and metabolic markers have been demonstrated. However, published data are inconsistent; controversies persist around the exact role of DHEA replacement and around which patient cohorts are most likely to benefit. There is also a paucity of recent randomized controlled trials in the medical literature to inform on optimal dose and duration of DHEA replacement in adrenal failure.SummaryHere, we review the evidence for DHEA supplementation in patients with adrenal insufficiency. We highlight knowledge gaps in the medical literature and areas that should be prioritized for future research endeavours.

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Mapping the Steroid Response to Major Trauma from Injury to Recovery: A Prospective Cohort Study

Cited by 5 publications

References 46 publications

Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome?

Neuroendocrine Modulation of the Immune Response after Trauma and Sepsis: Does It Influence Outcome?

Monitoring muscle mass using ultrasound: a key role in critical care

The role for long-term use of dehydroepiandrosterone in adrenal insufficiency

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