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Báo cáo khoa học: " Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Science review: Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids. | Available online http ccforum.eom content 8 4 243 Review Science review Mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids Hélène Prigent1 Virginie Maxime1 and Djillali Annane2 Senior Resident Service de Réanimation Médicale Hôpital Raymond Poincaré Assistance Publique Hôpitaux de Paris Faculté de Médecine Paris Ile de France Ouest Université de Versailles Saint-Quentin en Yvelines Garches France 2Director of the ICU Service de Réanimation Médicale Hôpital Raymond Poincaré Assistance Publique Hôpitaux de Paris Faculté de Médecine Paris Ile de France Ouest Université de Versailles Saint-Quentin en Yvelines Garches France Corresponding author Professor Djillali Annane djillali.annane@rpc.ap-hop-paris.fr Published online 25 May 2004 This article is online at http ccforum.com content 8 4 243 2004 BioMed Central Ltd Critical Care 2004 8 243-252 DOI 10.1186 cc2878 Abstract This review describes current knowledge on the mechanisms that underlie glucocorticoid insufficiency in sepsis and the molecular action of glucocorticoids. In patients with severe sepsis numerous factors predispose to glucocorticoid insufficiency including drugs coagulation disorders and inflammatory mediators. These factors may compromise the hypothalamic-pituitary axis i.e. secondary adrenal insufficiency or the adrenal glands i.e. primary adrenal failure or may impair glucocorticoid access to target cells i.e. peripheral tissue resistance . Irreversible anatomical damages to the hypothalamus pituitary or adrenal glands rarely occur. Conversely transient functional impairment in hormone synthesis may be a common complication of severe sepsis. Glucocorticoids interact with a specific cytosolic glucocorticoid receptor which undergoes conformational changes sheds heat shock proteins and translocates to the nucleus. Glucocorticoids may also interact with membrane binding sites at the surface of the cells. The molecular action of glucocorticoids results in genomic .