Ilias Ioannis, Vassiliou Alice G, Keskinidou Chrysi, Vrettou Charikleia S, Orfanos Stylianos, Kotanidou Anastasia, Dimopoulou Ioanna
Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, GR-11521 Athens, Greece.
1st Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, GR-10676 Athens, Greece.
Biomedicines. 2023 Jun 23;11(7):1801. doi: 10.3390/biomedicines11071801.
Sepsis is associated with dysregulated cortisol secretion, leading to abnormal levels of cortisol in the blood. In the early stages of the condition, cortisol levels are typically elevated due to increased secretion from the adrenal glands. However, as the disease progresses, cortisol levels may decline due to impaired adrenal function, leading to relative adrenal insufficiency. The latter is thought to be caused by a combination of factors, including impaired adrenal function, decreased production of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) by the hypothalamus and pituitary gland, and increased breakdown of cortisol. The dysregulation of cortisol secretion in sepsis is thought to contribute to the pathophysiology of the disease by impairing the body's ability to mount an appropriate inflammatory response. Given the dysregulation of cortisol secretion and corticosteroid receptors in sepsis, there has been considerable interest in the use of steroids as a treatment. However, clinical trials have yielded mixed results and corticosteroid use in sepsis remains controversial. In this review, we will discuss the changes in cortisol secretion and corticosteroid receptors in critically ill patients with sepsis/septic shock. We will also make special note of COVID-19 patients, who presented a recent challenge for ICU management, and explore the scope for corticosteroid administration in both COVID-19 and non-COVID-19 septic patients.
脓毒症与皮质醇分泌失调有关，导致血液中皮质醇水平异常。在该病症的早期阶段，由于肾上腺分泌增加，皮质醇水平通常会升高。然而，随着疾病进展，由于肾上腺功能受损，皮质醇水平可能会下降，导致相对性肾上腺皮质功能不全。后者被认为是由多种因素共同作用引起的，包括肾上腺功能受损、下丘脑和垂体分泌促肾上腺皮质激素释放激素（CRH）和促肾上腺皮质激素（ACTH）减少以及皮质醇分解增加。脓毒症中皮质醇分泌失调被认为通过损害机体产生适当炎症反应的能力而促成该疾病的病理生理过程。鉴于脓毒症中皮质醇分泌和糖皮质激素受体的失调，人们对使用类固醇作为治疗方法产生了浓厚兴趣。然而，临床试验结果不一，脓毒症中使用皮质类固醇仍然存在争议。在本综述中，我们将讨论脓毒症/脓毒性休克重症患者皮质醇分泌和糖皮质激素受体的变化。我们还将特别关注新型冠状病毒肺炎（COVID-19）患者，他们给重症监护病房（ICU）管理带来了新挑战，并探讨在COVID-19和非COVID-19脓毒症患者中使用皮质类固醇的范围。
