Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Department of General Surgery, St. Elisabeth’s Hospital, Graz, Austria
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The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70%. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction additionally increases the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels. Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis. It is biologically plausible that vitamin D deficiency is an important and modifiable contributor to poor prognosis during and after critical illness. Although vitamin D supplementation is inexpensive, simple and has an excellent safety profile, testing for and treating vitamin D deficiency is currently not routinely performed. Overall, less than 800 patients have been included in RCTs worldwide, but the available data suggest that high-dose vitamin D supplementation could be beneficial. Two large RCTs in Europe and the United States, together aiming to recruit >5000 patients, have started in 2017, and will greatly improve our knowledge in this field. This review aims to summarize current knowledge in this interdisciplinary topic and give an outlook on its highly dynamic future.
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Department of Neuroscience, Georgetown University, Washington, District of Columbia, USA
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Introduction Stress reactions are by no means universal, and the activation of ‘stress hormones’, such as glucocorticoids or corticotropin-releasing hormone (CRH), is not necessarily the mark of a stress response ( 1 ). Some individuals have
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the context of the stress response, it is important to remember that the HPA axis is only one of many stress-responsive systems within the body ( 15 , 18 ). A stressor is a real or perceived threat to homeostasis or well-being. This definition
Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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Faculty of Medicine, University of Basel, Basel, Switzerland
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endocrine stress response and stabilize blood hemostasis through vasoconstrictive effects and the overwhelming immune response through immunomodulatory effects ( 5 ). While pharmacological treatment of sepsis patients with vasopressin did not appear to lower
DFBMC, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
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DFBMC, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
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are essential to the stress response driving both basal and stress-induced hypothalamic–pituitary–adrenal axis (HPA) activation. Besides the hypothalamus, CRH is widely distributed in extrahypothalamic circuits of the brain where it functions as a
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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glucocorticoid treatment has been effective in improving outcomes in patients with hypoxemic COVID-19 ( 9 ). This suggests an inadequate physiological stress response in COVID-19 patients. Our findings do not support the presence of CIRCI at an enzymatic level in
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Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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is also involved in the response to acute stressors such as major surgery ( 12 ) and stress-induced gastric mucosal injury ( 13 , 14 ). Ghrelin stimulates the secretion of hormones involved in the stress response, including vasopressin, ACTH
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pathways may play a role in mediating the stress response (14) . Therefore, it is possible that various factors that were not investigated in this experiment are involved in mediating the effects of stress in lean and overweight/obese men. Further research
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girls with MAS-associated PPP and may impair the adrenocortical stress response ( 9 ). A 36-month trial of the third-generation aromatase inhibitor letrozole in ten girls with MAS-associated PP found a significant decrease in the growth velocity standard
BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
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Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
Department of Biology and Biochemistry, University of Bath, UK
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Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
Department of Biology and Biochemistry, University of Bath, UK
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Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
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BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
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BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
Department of Child Health, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
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increase in CORT released under acute restraint stress, indicating an altered neuroendocrine stress response. After treatment with DEX, the HPE response to restraint stress was suppressed in both brain-injured and uninjured sham rats, indicating an intact
