Glucocorticoids in sepsis: dissecting facts from fiction
Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, 825 Fairfax Ave, Suite 410, Norfolk, VA 23507, USA
Critical Care 2011, 15:158 doi:10.1186/cc10101
See related letter by Sprung et al. http://ccforum.com/content/15/5/446Published: 6 May 2011
An intact hypothalamic-pituitary-adrenal (HPA) axis with effective intracellular glucocorticoid anti-inflammatory activity is essential for host survival following exposure to an infectious agent. Glucocorticoids play a major role in regulating the activity of nuclear factorkappa- B, which has a crucial and generalized role in inducing cytokine gene transcription after exposure to an invading pathogen. Severe sepsis is, however, associated with complex alterations of the HPA axis, which may result in decreased production of cortisol as well as glucocorticoid tissue resistance.