Endocrine reviews最新文献

筛选
英文 中文
Metformin, Cognitive Function, and Changes in the Gut Microbiome. 二甲双胍、认知功能和肠道微生物组的变化
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2024-03-04 DOI: 10.1210/endrev/bnad029
Marisel Rosell-Díaz, José Manuel Fernández-Real
{"title":"Metformin, Cognitive Function, and Changes in the Gut Microbiome.","authors":"Marisel Rosell-Díaz, José Manuel Fernández-Real","doi":"10.1210/endrev/bnad029","DOIUrl":"10.1210/endrev/bnad029","url":null,"abstract":"<p><p>The decline in cognitive function and the prevalence of neurodegenerative disorders are among the most serious threats to health in old age. The prevalence of dementia has reached 50 million people worldwide and has become a major public health problem. The causes of age-related cognitive impairment are multiple, complex, and difficult to determine. However, type 2 diabetes (T2D) is linked to an enhanced risk of cognitive impairment and dementia. Human studies have shown that patients with T2D exhibit dysbiosis of the gut microbiota. This dysbiosis may contribute to the development of insulin resistance and increased plasma lipopolysaccharide concentrations. Metformin medication mimics some of the benefits of calorie restriction and physical activity, such as greater insulin sensitivity and decreased cholesterol levels, and hence may also have a positive impact on aging in humans. According to recent human investigations, metformin might partially restore gut dysbiosis related to T2D. Likewise, some studies showed that metformin reduced the risk of dementia and improved cognition, although not all studies are concordant. Therefore, this review focused on those human studies describing the effects of metformin on the gut microbiome (specifically the changes in taxonomy, function, and circulating metabolomics), the changes in cognitive function, and their possible bidirectional implications.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"210-226"},"PeriodicalIF":20.3,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10911951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10038738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Emerging Therapeutic Potential of Kisspeptin and Neurokinin B. Kisspeptin 和神经激肽 B 的新兴治疗潜力
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad023
Bijal Patel, Kanyada Koysombat, Edouard G Mills, Jovanna Tsoutsouki, Alexander N Comninos, Ali Abbara, Waljit S Dhillo
{"title":"The Emerging Therapeutic Potential of Kisspeptin and Neurokinin B.","authors":"Bijal Patel, Kanyada Koysombat, Edouard G Mills, Jovanna Tsoutsouki, Alexander N Comninos, Ali Abbara, Waljit S Dhillo","doi":"10.1210/endrev/bnad023","DOIUrl":"10.1210/endrev/bnad023","url":null,"abstract":"<p><p>Kisspeptin (KP) and neurokinin B (NKB) are neuropeptides that govern the reproductive endocrine axis through regulating hypothalamic gonadotropin-releasing hormone (GnRH) neuronal activity and pulsatile GnRH secretion. Their critical role in reproductive health was first identified after inactivating variants in genes encoding for KP or NKB signaling were shown to result in congenital hypogonadotropic hypogonadism and a failure of pubertal development. Over the past 2 decades since their discovery, a wealth of evidence from both basic and translational research has laid the foundation for potential therapeutic applications. Beyond KP's function in the hypothalamus, it is also expressed in the placenta, liver, pancreas, adipose tissue, bone, and limbic regions, giving rise to several avenues of research for use in the diagnosis and treatment of pregnancy, metabolic, liver, bone, and behavioral disorders. The role played by NKB in stimulating the hypothalamic thermoregulatory center to mediate menopausal hot flashes has led to the development of medications that antagonize its action as a novel nonsteroidal therapeutic agent for this indication. Furthermore, the ability of NKB antagonism to partially suppress (but not abolish) the reproductive endocrine axis has supported its potential use for the treatment of various reproductive disorders including polycystic ovary syndrome, uterine fibroids, and endometriosis. This review will provide a comprehensive up-to-date overview of the preclinical and clinical data that have paved the way for the development of diagnostic and therapeutic applications of KP and NKB.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"30-68"},"PeriodicalIF":20.3,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10765167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks. 治疗原发性醛固酮增多症诱发的高血压:新方法与未来展望。
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad026
Nathan Mullen, James Curneen, Padraig T Donlon, Punit Prakash, Irina Bancos, Mark Gurnell, Michael C Dennedy
{"title":"Treating Primary Aldosteronism-Induced Hypertension: Novel Approaches and Future Outlooks.","authors":"Nathan Mullen, James Curneen, Padraig T Donlon, Punit Prakash, Irina Bancos, Mark Gurnell, Michael C Dennedy","doi":"10.1210/endrev/bnad026","DOIUrl":"10.1210/endrev/bnad026","url":null,"abstract":"<p><p>Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared with blood pressure-matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for nonsurgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine-learning algorithms have shown promise in the prediction of PA subtypes, while the development of noninvasive alternatives to adrenal vein sampling (including molecular positron emission tomography imaging) has made accurate localization of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilization, for this highly prevalent disorder.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"125-170"},"PeriodicalIF":20.3,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10765166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9966657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biomarkers to Guide Medical Therapy in Primary Aldosteronism. 指导原发性醛固酮增多症药物治疗的生物标志物。
IF 22 1区 医学
Endocrine reviews Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad024
Gregory L Hundemer, Alexander A Leung, Gregory A Kline, Jenifer M Brown, Adina F Turcu, Anand Vaidya
{"title":"Biomarkers to Guide Medical Therapy in Primary Aldosteronism.","authors":"Gregory L Hundemer, Alexander A Leung, Gregory A Kline, Jenifer M Brown, Adina F Turcu, Anand Vaidya","doi":"10.1210/endrev/bnad024","DOIUrl":"10.1210/endrev/bnad024","url":null,"abstract":"<p><p>Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin-biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"69-94"},"PeriodicalIF":22.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10765164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9776716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Radiation-Related Thyroid Cancer. 与辐射相关的甲状腺癌
IF 22 1区 医学
Endocrine reviews Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad022
Vladimir Saenko, Norisato Mitsutake
{"title":"Radiation-Related Thyroid Cancer.","authors":"Vladimir Saenko, Norisato Mitsutake","doi":"10.1210/endrev/bnad022","DOIUrl":"10.1210/endrev/bnad022","url":null,"abstract":"<p><p>Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plant accidents are described, summarizing the information on thyroid cancer epidemiology, treatment, and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers have evolved in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the 2 areas reveals numerous differences that cumulatively suggest the low probability of the radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For external exposures, reasonable measures are generally in line with the As Low As Reasonably Achievable principle, while for internal irradiation from radioactive iodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"1-29"},"PeriodicalIF":22.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10765163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9781177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Crosstalk Between the Neuroendocrine System and Bone Homeostasis. 神经内分泌系统与骨平衡之间的相互关系
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2024-01-04 DOI: 10.1210/endrev/bnad025
Yuhu Zhao, Xiaole Peng, Qing Wang, Zhiyu Zhang, Liangliang Wang, Yaozeng Xu, Huilin Yang, Jiaxiang Bai, Dechun Geng
{"title":"Crosstalk Between the Neuroendocrine System and Bone Homeostasis.","authors":"Yuhu Zhao, Xiaole Peng, Qing Wang, Zhiyu Zhang, Liangliang Wang, Yaozeng Xu, Huilin Yang, Jiaxiang Bai, Dechun Geng","doi":"10.1210/endrev/bnad025","DOIUrl":"10.1210/endrev/bnad025","url":null,"abstract":"<p><p>The homeostasis of bone microenvironment is the foundation of bone health and comprises 2 concerted events: bone formation by osteoblasts and bone resorption by osteoclasts. In the early 21st century, leptin, an adipocytes-derived hormone, was found to affect bone homeostasis through hypothalamic relay and the sympathetic nervous system, involving neurotransmitters like serotonin and norepinephrine. This discovery has provided a new perspective regarding the synergistic effects of endocrine and nervous systems on skeletal homeostasis. Since then, more studies have been conducted, gradually uncovering the complex neuroendocrine regulation underlying bone homeostasis. Intriguingly, bone is also considered as an endocrine organ that can produce regulatory factors that in turn exert effects on neuroendocrine activities. After decades of exploration into bone regulation mechanisms, separate bioactive factors have been extensively investigated, whereas few studies have systematically shown a global view of bone homeostasis regulation. Therefore, we summarized the previously studied regulatory patterns from the nervous system and endocrine system to bone. This review will provide readers with a panoramic view of the intimate relationship between the neuroendocrine system and bone, compensating for the current understanding of the regulation patterns of bone homeostasis, and probably developing new therapeutic strategies for its related disorders.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"95-124"},"PeriodicalIF":20.3,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9824207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Pregnancy-Associated Plasma Protein-A (PAPP-A) Story. 妊娠相关血浆蛋白a (pap - a)的故事。
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad017
Cheryl A Conover, Claus Oxvig
{"title":"The Pregnancy-Associated Plasma Protein-A (PAPP-A) Story.","authors":"Cheryl A Conover, Claus Oxvig","doi":"10.1210/endrev/bnad017","DOIUrl":"10.1210/endrev/bnad017","url":null,"abstract":"<p><p>Pregnancy-associated plasma protein-A (PAPP-A) was first identified in the early 1970s as a placental protein of unknown function, present at high concentrations in the circulation of pregnant women. In the mid-to-late 1990s, PAPP-A was discovered to be a metzincin metalloproteinase, expressed by many nonplacental cells, that regulates local insulin-like growth factor (IGF) activity through cleavage of high-affinity IGF binding proteins (IGFBPs), in particular IGFBP-4. With PAPP-A as a cell surface-associated enzyme, the reduced affinity of the cleavage fragments results in increased IGF available to bind and activate IGF receptors in the pericellular environment. This proteolytic regulation of IGF activity is important, since the IGFs promote proliferation, differentiation, migration, and survival in various normal and cancer cells. Thus, there has been a steady growth in investigation of PAPP-A structure and function outside of pregnancy. This review provides historical perspective on the discovery of PAPP-A and its structure and cellular function, highlights key studies of the first 50 years in PAPP-A research, and introduces new findings from recent years.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"1012-1028"},"PeriodicalIF":20.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9568799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Update on Adipose Tissue and Cancer. 脂肪组织与癌症的最新进展。
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad015
Kristy A Brown, Philipp E Scherer
{"title":"Update on Adipose Tissue and Cancer.","authors":"Kristy A Brown, Philipp E Scherer","doi":"10.1210/endrev/bnad015","DOIUrl":"10.1210/endrev/bnad015","url":null,"abstract":"<p><p>Adipose tissue is the largest endocrine organ and an accepted contributor to overall energy homeostasis. There is strong evidence linking increased adiposity to the development of 13 types of cancer. With increased adiposity comes metabolic dysfunction and insulin resistance, and increased systemic insulin and glucose support the growth of many cancers, including those of the colon and endometrium. There is also an important direct crosstalk between adipose tissue and various organs. For instance, the healthy development and function of the mammary gland, as well as the development, growth, and progression of breast cancer, are heavily impacted by the breast adipose tissue in which breast epithelial cells are embedded. Cells of the adipose tissue are responsive to external stimuli, including overfeeding, leading to remodeling and important changes in the secretion of factors known to drive the development and growth of cancers. Loss of factors like adiponectin and increased production of leptin, endotrophin, steroid hormones, and inflammatory mediators have been determined to be important mediators of the obesity-cancer link. Obesity is also associated with a structural remodeling of the adipose tissue, including increased localized fibrosis and disrupted angiogenesis that contribute to the development and progression of cancers. Furthermore, tumor cells feed off the adipose tissue, where increased lipolysis within adipocytes leads to the release of fatty acids and stromal cell aerobic glycolysis leading to the increased production of lactate. Both have been hypothesized to support the higher energetic demands of cancer cells. Here, we aim to provide an update on the state of the literature revolving around the role of the adipose tissue in cancer initiation and progression.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"961-974"},"PeriodicalIF":20.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9868789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics. 子宫内膜异位症的表观遗传失调:病理生理学和治疗的意义。
IF 22 1区 医学
Endocrine reviews Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad020
Ryan M Marquardt, Dinh Nam Tran, Bruce A Lessey, Md Saidur Rahman, Jae-Wook Jeong
{"title":"Epigenetic Dysregulation in Endometriosis: Implications for Pathophysiology and Therapeutics.","authors":"Ryan M Marquardt, Dinh Nam Tran, Bruce A Lessey, Md Saidur Rahman, Jae-Wook Jeong","doi":"10.1210/endrev/bnad020","DOIUrl":"10.1210/endrev/bnad020","url":null,"abstract":"<p><p>Endometriosis is a prevalent gynecological condition associated with pelvic pain and infertility. Despite more than a century of research, the etiology of endometriosis still eludes scientific consensus. This lack of clarity has resulted in suboptimal prevention, diagnosis, and treatment options. Evidence of genetic contributors to endometriosis is interesting but limited; however, significant progress has been made in recent years in identifying an epigenetic role in the pathogenesis of endometriosis through clinical studies, in vitro cell culture experiments, and in vivo animal models. The predominant findings include endometriosis-related differential expression of DNA methyltransferases and demethylases, histone deacetylases, methyltransferases, and demethylases, and regulators of chromatin architecture. There is also an emerging role for miRNAs in controlling epigenetic regulators in the endometrium and endometriosis. Changes in these epigenetic regulators result in differential chromatin organization and DNA methylation, with consequences for gene expression independent of a genetic sequence. Epigenetically altered expression of genes related to steroid hormone production and signaling, immune regulation, and endometrial cell identity and function have all been identified and appear to play into the pathophysiological mechanisms of endometriosis and resulting infertility. This review summarizes and critically discusses early seminal findings, the ever-growing recent evidence of epigenetic contributions to the pathophysiology of endometriosis, and implications for proposed epigenetically targeted therapeutics.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"1074-1095"},"PeriodicalIF":22.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Hypothalamus-pituitary-adrenocortical Response to Critical Illness: A Concept in Need of Revision. 下丘脑-垂体-肾上腺皮质对危重疾病的反应:一个需要修正的概念。
IF 20.3 1区 医学
Endocrine reviews Pub Date : 2023-11-09 DOI: 10.1210/endrev/bnad021
Lies Langouche, Arno Téblick, Jan Gunst, Greet Van den Berghe
{"title":"The Hypothalamus-pituitary-adrenocortical Response to Critical Illness: A Concept in Need of Revision.","authors":"Lies Langouche, Arno Téblick, Jan Gunst, Greet Van den Berghe","doi":"10.1210/endrev/bnad021","DOIUrl":"10.1210/endrev/bnad021","url":null,"abstract":"<p><p>Based on insights obtained during the past decade, the classical concept of an activated hypothalamus-pituitary-adrenocortical axis in response to critical illness is in need of revision. After a brief central hypothalamus-pituitary-adrenocortical axis activation, the vital maintenance of increased systemic cortisol availability and action in response to critical illness is predominantly driven by peripheral adaptations rather than by an ongoing centrally activated several-fold increased production and secretion of cortisol. Besides the known reduction of cortisol-binding proteins that increases free cortisol, these peripheral responses comprise suppressed cortisol metabolism in liver and kidney, prolonging cortisol half-life, and local alterations in expression of 11βHSD1, glucocorticoid receptor-α (GRα), and FK506 binding protein 5 (FKBP51) that appear to titrate increased GRα action in vital organs and tissues while reducing GRα action in neutrophils, possibly preventing immune-suppressive off-target effects of increased systemic cortisol availability. Peripherally increased cortisol exerts negative feed-back inhibition at the pituitary level impairing processing of pro-opiomelanocortin into ACTH, thereby reducing ACTH-driven cortisol secretion, whereas ongoing central activation results in increased circulating pro-opiomelanocortin. These alterations seem adaptive and beneficial for the host in the short term. However, as a consequence, patients with prolonged critical illness who require intensive care for weeks or longer may develop a form of central adrenal insufficiency. The new findings supersede earlier concepts such as \"relative,\" as opposed to \"absolute,\" adrenal insufficiency and generalized systemic glucocorticoid resistance in the critically ill. The findings also question the scientific basis for broad implementation of stress dose hydrocortisone treatment of patients suffering from acute septic shock solely based on assumption of cortisol insufficiency.</p>","PeriodicalId":11544,"journal":{"name":"Endocrine reviews","volume":" ","pages":"1096-1106"},"PeriodicalIF":20.3,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10638597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
相关产品
×
本文献相关产品
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信