The hypothalamic-pituitary-adrenal axis and low-dose glucocorticoids in the treatment of septic shock.
Severe sepsis is the leading cause of death among patients in intensive care units. Recombinant activated protein C is the only substance known to directly improve morbidity and mortality. Adrenal insufficiency occurs frequently in patients with sepsis and is associated with poor outcome. Although high-dose glucocorticoids have not positively affected clinical outcome, small trials in which low-dose glucocorticoids were administered to patients with septic shock and relative adrenal insufficiency have shown decreased mortality. The main effect of glucocorticoids in low-doses apparently is exerted through correction of suppression of the hypothalamic-pituitary-adrenal axis. However, the therapeutic benefits of glucocorticoids may be related to their antiinflammatory properties and endogenous catecholamine-enhancing effects.
Williamson
David R
DR
Pharmacy Faculty, University of Montreal, Department of Pharmacy Services, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. david.williamson@umontreal.ca
Lapointe
Marc
M
D000818:Animals; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000378:metabolism; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000378:metabolism; D012772:Shock, Septic / Q000188:drug therapy* / Q000378:metabolism
D005938:Glucocorticoids