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18 Neuroendocrine Consequences of Systemic Inflammation
Pages 391-408

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From page 391...
... National Academy Press 18 Neuroenclocrine Consequences of Systemic Inflammation Seymour Reichlin~ INTRODUCTION Bacterial and viral infections, bacterial toxins, and severe tissue injury induce a relatively stereotypical pathophysiologic response manifested by fever, catabolism, and sickness behavior. If mild, sickness behavior is manifested by anorexia, drowsiness, and impaired cognition; if severe, delirium, stupor, and coma can supervene.
From page 392...
... These changes are mediated by a flood of polypeptide molecules, the inflammatory cytokines, which are released into the circulation by lymphocytes, monocytes, macrophages, and endothelial cells and are produced locally in tissues by resident macrophages and several other types of parenchymal cells. Among the most important of the cytokines released during inflammatory stress are interleukin (IL)
From page 393...
... As discussed in the text, endotoxin acts by mobilizing peripheral release of inflammatory cytokines, tumor necrosis factor (TNF) , and interleukin (IL)
From page 394...
... . The vagal afferent system, which acts through chemosensory vagal paraganglia is especially vulnerable to toxic products arising in the abdomen viscera.
From page 395...
... -1 (a or p) , IL-2, IL-6, and tumor necrosis factor (TNF)
From page 396...
... Although it is well established that patients with adrenal deficiency are more likely to die during sepsis than those with normal adrenal function, most studies show that treatment of sepsis with glucocorticoids in patients with normal adrenal function does not improve survival, and in fact, it may increase mortality (Sheagren, 1991~. These observations suggest that otherwise healthy individuals respond to sepsis with an appropriate pituitary-adrenal response.
From page 397...
... There is a downside to the VP response because it stimulates the kidney to delay water excretion, which in septic and elderly individuals enhances the vulnerability to overhydration. PITUITARY-THYROID REGULATION IN INFLAMMATORY DISEASE The sick euthyroid syndrome is the most common form of thyroid abnormality encountered in populations of acute and chronically ill individuals.
From page 398...
... Thyroid hormone treatment had no benefit (nor did harm) to a relatively small number of septic individuals with the sick euthyroid syndrome (Brent and Hershman, 1986)
From page 399...
... . In what may be an analogous situation the catabolic state associated with large burns blood GH levels are elevated, somatomedin values are low, but the administration of additional amounts of GH appear to improve survival and graft healing and to shorten the duration of hospitalization (Knox et al., 1995; Nguyen et al., 19961.
From page 400...
... Glucocorticoid treatment will be unlikely to help manage stress in individuals whose underlying adrenal reserve is normal. Studies designed specifically to evaluate thyroid status under field conditions of stress and malnutrition would be of value, but on the basis of He limited information on treatment of sick euthyroid patients with thyroid hormone, it is unlikely that this form of therapy will be helpfill.
From page 401...
... 1991. Hormone specific regulation of natural killer cells by cortisol: Direct inactivation of the cytotoxic function of cloned human NK cells without an effect on cellular proliferation.
From page 402...
... 1989. Impairment of hypothalamicpituitary-thyroid function in rats treated with human recombinant tumor necrosis factor-a (cachectin)
From page 403...
... 1991. Vasopressin mediates the interleukin-la-induced reduced decrease in luteinizing hormone secretion in the ovariectomized rhesus monkey.
From page 404...
... 1990. Tumor necrosis factor: A putative mediator of the sick euthyroid syndrome in man.
From page 405...
... Since blood draws in major studies have always been done in the morning, it is very hard to get a feel for what is going on in the circadian rhythm of cortisol secretion, and if indeed that reflects a systemic inflammatory response, and we did some preliminary studies with salivary cortisol that suggested that in some of the subjects, the circadian rhythm was lost, but measuring salivary cortisol levels may be a very interesting way to gain data tracking the circadian rhythm, which would make a lot more sense. And my other question is as IGF [insulin-like growth factor]
From page 406...
... They found that carbohydrate replacement in sick euthyroid patients reversed the low T3 levels. It would be, from my point of view, extremely important to look at the other side of the coin, that is, the effect of nutritional status on cytokine production.
From page 407...
... Also, effects that we observed with LPS can be blocked only partially with TNF-a, soluble receptor, and IL-1 receptor antagonist (Romero et al., 1996~. The effects of bacterial toxin are mediated by many factors.


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