Critical endocrinology of suprarenal glands and the adrenal hypothalamic axis
Review Article
Keywords:
hypothalamo-hypophyseal system, adrenal insufficiency, adrenal glandsAbstract
The concept of relative adrenal insufficiency is currently predominant and is the paradigm that governs glucocorticoid treatment in critically ill patients. In this chapter, we propose a new criterion that allows a deeper revision at the cellular and molecular level and expands the criterion to a hypothalamic-pituitary-adrenal-cell axis under physiological-molecular foundations established in recent years The history of therapeutics is reviewed steroid until you get to the current indications. The lack of scientific evidence is recognized throughout the ages for full justification of its administration. In the absence of objective scientific evidence, the presence of relative adrenal insufficiency is discussed, which makes it possible to postulate the existence of peripheral adrenal insufficiency and/or resistance to cortisol. The therapeutic attitude supported in the new peripheral criterion of adrenal insufficiency is proposed and the need for further research on this unresolved issue is recognized. The final approach of this topic calls for a broader vision that goes beyond the hypothalamic-pituitary axis.
References
González-Albarrán O, Fraile J, García Robles R. Fisiología de las glándulas suprarrenales. Medicine - Programa de Formación Médica Continuada Acreditado [Internet]. 2000 [cited 03 January 2019];8(21):1097-1101. DOI: 10.1016/S0304-5412(00)70206-X.
Guerrero J. Para entender la acción de cortisol en inflamación aguda: una mirada desde la glándula suprarrenal hasta la célula blanco. Revista médica de Chile [Internet]. 2017 [cited 03 January 2019];145(2):230-239. DOI: 10.4067/S0034-98872017000200011.
McNeilly A, Macfarlane D, O’Flaherty E, Livingstone D, Miti? T, McConnell K et al. Bile acids modulate glucocorticoid metabolism and the hypothalamic–pituitary–adrenal axis in obstructive jaundice. Journal of Hepatology [Internet]. 2010 [cited 3 January 2019];52(5):705-711. DOI: 10.1016/j.jhep.2009.10.037.
Bornstein S, Chrousos G. Adrenocorticotropin (ACTH)- and Non-ACTH-Mediated Regulation of the adrenal cortex: Neural and immune inputs. The Journal of Clinical Endocrinology & Metabolism [Internet]. 1999 [cited 3 January 2019];84(5):1729-1736. DOI: 10.1210/jcem.84.5.5631.
Sapolsky R, Romero L, Munck A. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative Actions*. Endocrine Reviews [Internet]. 2000 [cited 3 January 2019];21(1):55-89. DOI: 10.1210/edrv.21.1.0389.
Marik PE. Critical Illness-Related corticosteroid insufficiency. Chest [Internet]. 2009 Jan 1 [cited 2019 Jan 3];135(1):181–93. Available from: sciencedirect.com.
Selye H. The evolution of the stress concept: The originator of the concept traces its development from the discovery in 1936 of the alarm reaction to modern therapeutic applications of syntoxic and catatoxic hormones [Internet]. Vol. 61, American Scientist. Sigma Xi, The Scientific Research Honor Society; [cited 2019 Jan 02]. p. 692–9. Available from: jstor.org.
Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA. A Controlled Clinical Trial of High-Dose Methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med [Internet]. 1987 Sep 10 [cited 2019 Jan 02];317(11):653–8. Available from: ncbi.nlm.nih.gov.
Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA. Early methylprednisolone treatment for septic syndrome and the adult respiratory distress syndrome. Chest [Internet]. 1987 Dec [cited 2019 Jan 02];92(6):1032–6. Available from: ncbi.nlm.nih.gov.
Veterans Administration Systemic Sepsis Cooperative Study Group. Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med [Internet]. 1987 Sep 10 [cited 2019 Jan 02];317(11):659–65. Available from: ncbi.nlm.nih.gov.
Luce JM, Montgomery AB, Marks JD, Turner J, Metz CA, Murray JF. Ineffectiveness of High-dose Methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis [Internet]. 1988 Jul [cited 2019 Jan 02];138(1):62–8. Available from: ncbi.nlm.nih.gov.
Lucas CE, Ledgerwood AM. The cardiopulmonary response to massive doses of steroids in patients with septic shock. Arch Surg [Internet]. 1984 May 1 [cited 2019 Jan 08];119(5):537. DOI: 10.1001/archsurg.1984.01390170037008.
Meduri GU, Headley AS, Golden E, Carson SJ, Umberger RA, Kelso T, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA [Internet]. 1998 Jul 8 [cited 2019 Jan 02];280(2):159–65. Available from: ncbi.nlm.nih.gov.
Gibbison B, López-López JA, Higgins JPT, Miller T, Angelini GD, Lightman SL, et al. Corticosteroids in septic shock: a systematic review and network meta-analysis. Crit Care. 2017;21(1).
Annane D, Troche G. A 3-Level prognostic classificationin septic shock based on cortisol levels and cortisol response to corticotropin. 2000;1–8. DOI: 10.1001/jama.283.8.1038.
Sprung CL, Annane D, Moreno R, Freivogel K, Weiss YG, Benbenishty J, et al. Hydrocortisone therapy for patients with septic shock [Internet]. Vol. 358, n engl j med. 2008 [cited 2019 Jan 02].
Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med [Internet]. 1999 Apr [cited 2019 Jan 02];27(4):723–32. Available from: ncbi.nlm.nih.gov.
Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis the Hypress randomized clinical trial. JAMA - J Am Med Assoc. 2016;316(17):1775–85. DOI: 10.1001/jama.2016.14799.
Venkatesh B, Finfer S, Cohen J, Rajbhandari D, Arabi Y, Bellomo R, et al. Adjunctive glucocorticoid therapy in patients with septic shock. The Adrenal Trial. N Engl J Med. 2018. DOI: 10.1056/NEJMoa1705835.
Molenaar N, Johan Groeneveld AB, Dijstelbloem HM, de Jong MFC, Girbes ARJ, Heijboer AC, et al. Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness. Intensive Care Med [Internet]. 2011 Dec 18 [cited 2019 Jan 05];37(12):1986–93. Available from: springer.com.
Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol in critically Ill patients. N Engl J Med [Internet]. 2004 Apr 15 [cited 2019 Jan 5];350(16):1629–38. Available from: nejm.org.
Moraes R, Friedman G, Tonietto T, Saltz H, Czepielewski M. Comparison of low and high dose cosyntropin stimulation tests in the diagnosis of adrenal insufficiency in septic shock patients. Horm Metab Res [Internet]. 2012 Apr 20 [cited 2019 Jan 5];44(4):296–301. DOI: 10.1055/s-0032-1304320.
Mesotten D, Vanhorebeek I, Van den Berghe G. The altered adrenal axis and treatment with glucocorticoids during critical illness. Nat Clin Pract Endocrinol Metab [Internet]. 2008 Sep 12 [cited 2019 Jan 3];4(9):496–505. DOI: 10.1038/ncpendmet0921.
Bhatia R, Muraskas J, Janusek LW, Mathews H. Measurement of the glucocorticoid receptor: Relevance to the diagnosis of critical illness–related corticosteroid insufficiency in children. J Crit Care [Internet]. 2014 Aug 1 [cited 2019 Jan 3];29(4):691.e1-691.e5. Available from: sciencedirect.com.
Van den Berghe G. Endocrine evaluation of patients with critical illness. Endocrinol Metab Clin North Am. 2003;32(2):385–410.
Boonen E, Van den Berghe G. Endocrine Responses to Critical Illness: Novel Insights and Therapeutic Implications. J Clin Endocrinol Metab [Internet]. 2014 May 1 [cited 2018 Dec 1];99(5):1569–82. DOI: 10.1210/jc.2013-4115.
Mateos Moreno L, Palacios García N, Estrada García FJ. Adrenal insufficiency in critical patients: New ethiopathogenic concepts and therapeutic implications. Endocrinol Diabetes y Nutr [Internet]. 2017;64(10):557–63. DOI: 10.1016/j.endinu.2017.09.004.
Boonen E, Vervenne H, Meersseman P, Andrew R, Mortier L, Declercq PE, et al. Reduced cortisol metabolism during critical illness. N Engl J Med [Internet]. 2013 Apr 18 [cited 2019 Jan 3];368(16):1477–88. DOI: 10.1056/NEJMoa1214969.
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Ciencia Ecuador
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
This is a human-readable summary of (and not a substitute for) the license.
You are free to:
Share — copy and redistribute the material in any medium or format
Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
