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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The metabolic response to sepsis is dependent on the hormonal status. However, reported plasma hormone levels vary widely among studies. The persistence of pulsatile secretion, as occurs normally, may explain the observed variability. To study whether pulsatile hormone secretion persists during sepsis and how it affects assessment of the hormonal status from single measurements, we measured growth hormone (GH), prolactin, cortisol, insulin, and C-peptide at 20-minute intervals for 24 hours in eight consecutive patients with severe sepsis. Twenty-four-hour averages (mean +/- SD) were 3.3 +/- 2.5 ng/mL for GH, 640 +/- 461 nmol/L for cortisol, 18.2 +/- 4.8 mU/L for insulin, and 3.4 +/- 2.9 U/L for C-peptide, at a pulse frequency between 3.3 +/- 2.7 for C-peptide and 10.2 +/- 3.4 for insulin, and an increase of the maximal value in a pulse above the preceding nadir of 131% +/- 13% for cortisol and 376% +/- 386% for GH, as assessed with Cluster analysis. Prolactin levels were below the detection limit in all but one patient, probably due to the administration of dopamine. To determine the accuracy of less frequent blood sampling regimens, we simulated different sampling strategies and compared them with the 24-hour averages. The accuracy of single samples proved inadequate for all hormones. Sampling every 20 minutes for periods of 4, 8, or 12 hours improved accuracy, but intermittent sampling every 1, 2, 4, or 6 hours during a 24-hour period yielded even more accurate results.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulsatile hormone secretion during severe sepsis: accuracy of different blood sampling regimens. 151 22

We studied serum prolactin (PRL) in 28 newborn infants with acute encephalopathy. Six patients had electrographically confirmed seizures. Twenty-two patients comprised the nonictal group. In the seizure group, PRL was determined at the first onset of the seizure (baseline) and at 15 and 30 min postictal. In the nonseizure group, PRL was determined at the end of the EEG and 15 min later. EEGs were visually analyzed for the presence of seizures and background abnormality (normal or mildly, moderately, or markedly abnormal). Etiologic diagnoses included congenital heart disease (12), hypoxic-ischemic encephalopathy (4), sepsis (4), respiratory distress syndrome (5) meconium aspiration (1), and metabolic disease (2). Serum PRL was significantly higher (p < 0.05) at baseline and 15 min postictally in the patients with seizures than in the nonictal group. However, PRL levels 15 and 30 min postictally were not statistically different from baseline values. Baseline PRL correlated significantly (p < 0.001) with EEG background abnormality in both groups; therefore, patients with the most abnormal EEG backgrounds had higher levels of PRL than those with a relatively normal EEG background. We conclude that newborns with EEG-confirmed seizures, particularly if seizures are not associated with clinical signs, have high baseline serum PRL levels that do not increase significantly in the immediate postictal period. Serum PRL levels correlate with the severity of the brain insult as evaluated by EEG background. Further studies are needed to enhance our understanding of the dynamics of PRL secretion in newborns with seizures and acute encephalopathy.
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PMID:Serum prolactin in neonates with seizures. 755 85

Although prolactin is reported to counteract the immunosuppressive effects of glucocorticoids, cyclosporine, and morphine, it remains unknown whether prolactin has any salutary effects on the depressed immune responses following severe hemorrhage. To study this, mice were bled to and maintained at a mean arterial pressure of 35 mm Hg for 60 min, then adequately resuscitated and divided into two groups. One group received saline vehicle, while the other group received prolactin (100 micro g/25 g body weight, s.c.) immediately before resuscitation. Two hours thereafter, peritoneal (pMphi) and splenic macrophages (sMphi) were harvested and assessed not only for their ability to release IL-1 and IL-6, but also for cytokine gene expression using semiquantitative reverse transcription and PCR. In an additional group, mice were subjected to sepsis by cecal ligation and puncture 3 days after hemorrhage. Hemorrhage markedly decreased the ability of pMphi and sMphi to release IL-1 and IL-6. This was, however, associated with increased mRNA expression for IL-1beta and IL-6 and increased serum corticosterone levels. Following prolactin treatment of hemorrhaged mice, IL-1beta and IL-6 mRNA levels as well as cytokine release capacity and blood corticosterone levels were comparable to the values in sham animals. Prolactin also improved the survival of animals subjected to sepsis after hemorrhage. Thus, the immunosuppression following hemorrhage appears to be mediated and modulated by hormones from the hypothalamic-pituitary-adrenal axis. Furthermore, prolactin represents a novel immunomodulating hormone for the treatment of immunodepression encountered after hemorrhagic shock and for decreasing the mortality from subsequent sepsis under those conditions.
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PMID:Prolactin administration following hemorrhagic shock improves macrophage cytokine release capacity and decreases mortality from subsequent sepsis. 895 29

Previous studies indicate a profound suppression of tumour necrosis factor alpha (TNF-gamma), IL-1 beta and IL-6 release capacity by peritoneal macrophage (PM phi), splenic macrophage (SM phi) and Kupffer cells (KC) during late sepsis. Such a loss of functional capacity may reduce the animal's ability to ward off infection. Prolactin is known to enhance monocyte, T- and B-lymphocyte immune responses under normal conditions and has beneficial effects on cell-mediated immunity after haemorrhage. In the respect, the dopamine antagonist, metoclopramide, has been reported to increase circulating prolactin levels. Nonetheless, it remains unknown whether prolactin or metoclopramide have any salutary effect on macrophage (M phi) cytokine gene expression following sepsis. To study this, male C3H/HeN mice were subjected to sepsis and immediately thereafter were treated with prolactin (100 micrograms/25 g body weight, s.c.), metoclopramide (100 micrograms/100 g BW, s.c.) or given saline. PM phi, SM phi and KC (only SM phi and KC in metoclopramide-treated animals) were isolated at 24 h after sepsis. The monolayers were stimulated with or without LPS 10 micrograms/ml for 1 h in vitro. Total RNA was extracted and mRNA was detected by semi-quantitative reverse transcription polymerase chain reaction (RT-PCR). A significant depression of constitutive and inducible mRNA levels of IL-1 beta, IL-6 and TNF-alpha in all three M phi populations were observed, when compared with shams (with exception of KC IL-6 mRNA in unstimulated cells). Prolactin as well as metoclopramide treatment after the onset of sepsis caused significant elevation of constitutive and inducible cytokine gene expression in all macrophages examined. Thus, prolactin and metoclopramide enhance the depressed M phi gene expression and may be useful in improving cell-mediated immunity during sepsis.
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PMID:Effects of prolactin and metoclopramide on macrophage cytokine gene expression in late sepsis. 919 78

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p < 0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p < 0.001). In the patients with stress ulcer, significant increases (p < 0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.
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PMID:Hypothalamic dysfunction in acute head-injured patients with stress ulcer. 979 99

In earlier studies it has been shown that prolactin (PRL) is a stimulating factor for the immune system, and it has been suggested that PRL might antagonize immunosuppressive effects of glucocorticoids. PRL has been reported to affect the cytokine secretion pattern, by elevating cytokine gene expression in macrophages, after the onset of sepsis. It also promotes the antibody response in mice where it increases the production of interferon-gamma (IFN-gamma) and inhibits interleukin-1 (IL-1) production. Due to these properties, PRL might influence the development of autoimmune type 1 diabetes. The aim of the present study was to examine the effects of two drugs; PRL and bromocriptine (BC) in vivo on the development of hyperglycemia and pancreatic insulitis in mice treated with multiple doses of streptozotocin (STZ) (40 mg/kg body weight, i.p.). The dopaminergic agonist BC is known to inhibit PRL secretion. In another set of experiments, the direct effects of PRL on the function of pancreatic islets exposed to STZ in vitro were studied. Mice treated with STZ became gradually hyperglycemic, and concomitant treatment with PRL (4 mg/kg body weight) for 21 days significantly reduced the elevation in blood glucose levels from day 10 onwards (P<0.05). Morphologic examinations of the pancreas on day 21 of mice receiving STZ injections revealed a marked insulitis, but only moderate insulitis in the STZ treated animals given PRL. BC administration (10 mg/kg body weight) in combination with STZ did not significantly affect the elevation in blood glucose levels or the insulitis. PRL or BC administration alone did not change the serum glucose concentration. This study indicates that PRL may affect hyperglycemia in the early phase of autoimmune diabetes. We suggest that it might be due to counteraction of autoimmune immunologic mechanisms and/or enhancement of beta-cell regeneration.
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PMID:Prolactin protects against diabetes induced by multiple low doses of streptozotocin in mice. 1055 72

We investigated the effects of sepsis, through the lipopolysaccharide (LPS)-induced inflammatory response, on plasma corticosterone and prolactin (PRL) levels during acute immobilization stress in normal and thyroidectomized rats. Thyroidectomized (TX) or sham-operated (N) rats were subjected to 120 min of immobilization stress. Rats were treated with an intraperitoneal injection of either LPS (250 microg (100 g body wt)(-1)) or the same volume of vehicle (saline solution), 90 min before the induction of stress. Blood samples for hormone assays were collected before sepsis and stress induction for baseline measures (-90 min), and during sepsis and immobilization stress for the measurement of prolactin and corticosterone levels by radioimmunoassay. Our results show that the thyroid hormones are necessary for a proper response of PRL and corticosterone release during immobilization stress. Although sepsis enhanced PRL secretion, this was not true of corticosterone release in either group of rats. Low levels of thyroid hormones partially block the release of PRL, but do not block corticosterone secretion during sepsis.
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PMID:Hypothyroidism attenuates stress-induced prolactin and corticosterone release in septic rats. 1460 74

Metoclopramide (MCP) has been demonstrated to restore the depressed cellular immune function after hemorrhage by increasing the release of the immunomodulatory pituitary hormone prolactin. We investigated the effect of MCP on serum prolactin concentrations, on cellular immune functions (immune cell distribution, splenocyte proliferation, apoptosis and cytokine release) and on the survival 48 h after induction of a polymicrobial sepsis in mice. Administration of MCP increased circulating serum prolactin concentrations and splenocyte apoptosis rate and improved cellular cytokine release, but did not affect mortality of septic mice. We therefore conclude that administration of MCP modulated splenocyte apoptosis and cytokine release in a murine model of sepsis without an impact on the survival. Furthermore, this effect may be mediated by an increased endogenous prolactin release.
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PMID:Metoclopramide and cellular immune functions during polymicrobial sepsis. 1500 65

Many studies show important disturbances in hormonal balance in patients with severe sepsis. There are a lot of factors, which are involved in this process but the role of sex steroid hormones is unknown; especially, the role of testosterone, which is one of the anabolic hormones and a immune function modulator. We hope that sex steroid hormone mechanisms of action recognition in septic shock may help in treatment of such patients. The aim of this study was to evaluate changes in sex hormone concentrations in septic patients and their prognostic significance. We studied serum level of luteinizing hormone (LH), testosterone (T) and prolactin (PRL) in 20 patients with septic shock and in healthy male volunteers (n = 20). Septic patients were divided into two groups: survivors (group I, n = 10) and nonsurvivors (group II, n = 10). We noticed significant decrease of testosterone and LH serum levels in septic group vs the controls and correlation between T and LH serum levels and survival. Acute lung injury was associated with higher PRL serum level and was independent from the LH and T serum level. We also noticed incorrect pituitary down-regulation of testosterone secretion. Our study showed that sex steroid hormones can be good prognostic factors of survival and complications of septic shock.
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PMID:[Serum levels of luteinizing hormone, testosterone and prolactin in patients with septic shock]. 1505 38

The growth of prostate cancer is controlled by several hormones and growth factors. In cases of metastasized prostate cancer, antigonadotropic therapy is currently considered state-of-the-art treatment. Surgical therapies such as adrenalectomy and hypophysectomy are no longer in use. Nevertheless, hypophysectomy has proven efficacy for palliative pain treatment as well as increasing duration of survival. The authors present the case of a 63-year-old man with metastatic prostate cancer who presented with high serum prostate-specific antigen levels (1216 microg/L) and cavernous sinus syndrome. His disease was progressing despite leuprorelin and docetaxel therapy, and he had severe bone pain despite high-dose pain therapy. He was also anemic. Contrast-enhanced MR imaging showed a pituitary lesion as well as metastatic infiltration of the skull base including the cavernous sinus. The patient's serum level of prolactin was mildly elevated, testosterone was below the detection limit, and insulin-like growth factor-I (IGF-I) was in the upper range for a patient of his age (233 microg/L). Because of the elevated prolactin and high-normal IGF-I levels he was offered a hypophysectomy in addition to pituitary tumor removal. Histological examination of the resected lesion confirmed a nonsecreting pituitary adenoma with infiltration of prostate cancer cells. Postoperatively the patient's prostate-specific antigen levels dropped to 876 microg/L, his bone pain resolved, and the cavernous sinus syndrome improved. Nevertheless, he died of septicemia 4 months after surgery. Older publications as well as this case have shown the benefit of hypophysectomy for pain treatment. A reduction of IGF-I levels even in the final stage metastasized prostate cancer may play a major role. Respectively, clinical studies with somatostatin analogs are currently in progress, which may lead to a "new" way of treatment in these otherwise hopeless patients. On the basis of the pain relief seen after hypophysectomy in this case and similar benefits reported in older publications, the authors raise the question whether this treatment should be offered more frequently, and whether additional medical options of hormone treatment may be beneficial in similar cases.
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PMID:Hypophysectomy for prostate cancer: a revival of old knowledge? 1882 67


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