Neuroendocrine dysfunction in sepsis and its therapeutic strategy / 中华烧伤杂志

ABSTRACT

Severe sepsis provokes significant abnormalities in host neuroendocrine system, and they are hallmarked by the glucocorticoid and growth hormone resistance, vasopressin deficiency, and compromised vagal activity. As a consequence, the increased stress hormones result in a hyperdynamic circulation, hypermetabolic state, and the hyperglycemia/insulin resistance in sepsis. The cardiac autonomic dysfunction also occurs as a consequence of depressed vagal activity. Current therapeutic strategies include insulin therapy to control hyperglycemia, physiologic doses of corticosteroids to improve immunity, growth hormone to reverse negative nitrogen balance, and vasopressin to raise blood pressure. Non-specific beta-adrenergic blockade has also been attempted to either attenuate the hypermetabolism or to reduce the inflammatory response. Future therapy may be directed at both central and peripheral immune system so as to alleviate the hyperdynamic inflammatory state and possibly encephalopathy in severe sepsis.