title: Hemodynamic actions of corticotropin-releasing hormone and proopiomelanocortin derivatives in septic patients.
abstract: Proopiomelanocortin (POMC) derivatives and mRNA of POMC have been detected in cardiomyocytes and vascular smooth muscle cells. Increased plasma levels of POMC derivatives have been found in septic patients during cardiovascular deregulation; therefore, we evaluated whether corticotroph-type (ACTH, β-endorphin, β-lipotropin) or melanotroph-type (α-melanocyte-stimulating hormone and N-acetyl-β-END) POMC derivatives have influences on patients' hemodynamics during sepsis. Seventeen septic patients were monitored by pulmonary artery catheter and corticotropin-releasing hormone (CRH) tests were performed by intravenous administration of 100 μg CRH. Before, 15, 30, 45, and 60 minutes after CRH administration, hemodynamic variables were measured, and plasma concentrations of POMC derivatives were determined. After CRH administration, heart rate, cardiac index, and stroke index increased, and the systemic vascular resistance index decreased; moreover, a correlation between ACTH concentration and stroke index as well as an inverse correlation between (α-melanocyte-stimulating hormone concentration and systemic vascular resistance index was observed. CRH and ACTH may have opposite effects on the blood pressure (mean arterial pressure). Immediately after CRH injection mean arterial pressure decreased. ACTH (in contrast to β-endorphin or β-lipotropin), released into the cardiovascular compartment 15 minutes after CRH injection, might have raised mean arterial pressure as compatible with the correlation between ACTH levels and stroke index. (α-melanocyte-stimulating hormone appears to have a vasodilative effect during sepsis.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy Justus-Liebig-University, Giessen, Germany. reginald.matejec@chiru.med.uni-giessen.de
authors.forename: Reginald
authors.initials: R
authors.lastname: Matejec
authors.forename: Gudrun
authors.initials: G
authors.lastname: Löcke
authors.forename: Friederike
authors.initials: F
authors.lastname: Kayser
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichtenstern
authors.forename: Markus Alexander
authors.initials: MA
authors.lastname: Weigand
authors.forename: Ingeborg Dorothea
authors.initials: ID
authors.lastname: Welters
authors.forename: Rolf-Hasso
authors.initials: RH
authors.lastname: Bödeker
authors.forename: Heinz-Wilhelm
authors.initials: HW
authors.lastname: Harbach
mesh_terms: D003346:Corticotropin-Releasing Hormone / Q000008:administration & dosage / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D011333:Pro-Opiomelanocortin / Q000494:pharmacology*; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000503:physiopathology*; D013997:Time Factors; D000521:alpha-MSH / Q000097:blood; D001615:beta-Endorphin / Q000097:blood; D008083:beta-Lipotropin / Q000097:blood
chemical_list: D000521:alpha-MSH; D001615:beta-Endorphin; D011333:Pro-Opiomelanocortin; D003346:Corticotropin-Releasing Hormone; D008083:beta-Lipotropin