The Neuroendocrine Response to Sepsis

  • D. Annane


Acute response to LPS includes the release of a number of proinflammatory mediators that reach the brain in areas free of blood-brain barrier, or via specific transport systems. The hypothalamic-pituitary axis is also activated via neural routes. Then, infection is characterized by high circulating levels of adrenocorticotrope hormone (ACTH), and cortisol which remain in plateau as long as the stressful condition is maintained. Circulating vasopressin levels follow a biphasic response with high concentrations, followed by relative vasopressin insufficiency in about one third of cases. Early response to sepsis is characterized by decreased serum T3 and increased rT3 levels. Serum T4 levels decrease within 24 to 48 h, and thyroid-stimulating (TSH) levels remain normal, and have no more circadian rhythm. Prolonged sepsis is associated with centrally induced hypothyroidism. In the initial response to sepsis, growth hormone levels are high with attenuated oscillatory activity and low insulin-like growth factor (IGF)-1 levels. Later on, growth hormone (GH) secretion shows a reduced pulsatil fraction, and correlates with low circulating levels of IGF-1. Exposure to endotoxin caused prompt increase in circulating adrenaline and noradrenaline concentrations. Catecholamines have a very short half-life and are metabolized through captation, enzymatic inactivation, or renal excretion. Plasma catecholamines levels remain elevated in plateau up to few months after recovery. Insulin levels rapidly increased following LPS as a result of both increased secretion and tissue resistance. The clinical consequences of the stress system activation include behavioral changes, cardiovascular, metabolic and immune adaptations.


Growth Hormone Septic Shock Critical Illness Migration Inhibit Factor Adrenal Medulla 
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© Springer-Verlag Italia 2009

Authors and Affiliations

  • D. Annane
    • 1
  1. 1.Service de Réanimation, Hôpital Raymond Poincaré (AP-HP)University of Versailles SQYGarchesFrance

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