The Function of the Adrenal Cortical Hormone and the Cause of Death from Adrenal Insufficiency

Swingle, W. W.; Pfiffner, J. J.; Vars, Harry M.; Bott, P. A.; Parkins, W. M.

doi:10.1126/science.77.1985.58

Cited by 78 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Swingle et al 13,14 first showed that animals with adrenalectomies died from hypovolemic and laparotomy-induced shock, which could be prevented with glucocorticoids. Animals with adrenal insufficiency have hemodynamic instability before, during and after surgery, as well as increased mortality.…”

Section: Relative Adrenal Insufficiency In Critical Illnessmentioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

View full text Add to dashboard Cite

Cortisol release in the face of illness or stress is vital for survival. Relative adrenal insufficiency occurs when a patient's cortisol response is inadequate for the degree of illness or stress. Numerous studies have documented the existence of relative adrenal insufficiency in critically ill adults, and its association with increased morbidity and mortality. There is increasing evidence that relative adrenal insufficiency may be an etiology for hemodynamic instability and hypotension in the critically ill newborn, but compared with the adult population, there is still a paucity of data in this population. Randomized controlled trials are needed to evaluate the efficacy and safety of glucocorticoids for the treatment of cardiovascular insufficiency due to relative adrenal insufficiency in ill preterm and term newborn infants. Keywords: adrenocorticotropin; ACTH; adrenal insufficiency; corticotrophin-releasing hormone; cortisol; critically ill infants hypothalamic-pituitary-adrenal axis; newborns-full term Introduction Activation of the hypothalamic-pituitary-adrenal (HPA) axis and ultimate release of cortisol are critical in maintaining homeostasis in response to stress. Relative adrenal insufficiency occurs when the HPA axis produces insufficient cortisol for the degree of illness or stress. In some critically ill adult populations, relative adrenal insufficiency is prevalent, 1-4 and is associated with increased morbidity and mortality. 2,3,5 Some studies of glucocorticoid treatment in critically ill adults have shown benefit, with faster reversal of shock and reduction in mortality. 3,[5][6][7][8] Recently, increasing evidence supports the existence of relative adrenal insufficiency in ill newborns, but, similar to other ill populations, there remains no general consensus on which patients should be tested, which tests to use and how to interpret them, which patients should be treated or how they should be treated. 9 The following discussion is an overview of corticosteroid physiology, relative adrenal insufficiency in critically ill populations and evidence of its existence in newborn infants, with proposed underlying

show abstract

Section: Relative Adrenal Insufficiency In Critical Illnessmentioning

confidence: 99%

Relative adrenal insufficiency in the preterm and term infant

2009

View full text Add to dashboard Cite

show abstract

“…In a series of papers Swingle and coworkers (19,20,21,22) have offered evidence that, in dogs, adrenal insufficiency is associated with hemoconcentration and lowered plasma volume. These investigators suggest that the chief physiological disturbance is depletion of the volume of extracellular fluid owing to shift of water from extracellular spaces into the cells (8,23).…”

Section: Discussionmentioning

confidence: 99%

The Distribution of Body Water and Electrolytes in Adrenal Insufficiency 1

Harrison¹,

Darrow²

1938

J. Clin. Invest.

View full text Add to dashboard Cite

The mode of action of the hormone of the adrenal cortex necessary for life has been the subject of much discussion. Among the prominent hypotheses for explaining the symptoms of adrenal cortical insufficiency are loss of sodium and chloride with accompanying changes in the distribution of body water (1, 2, 3); toxic effects of potassium (4,5,6,7); disturbance in the distribution of body water not clearly related to loss of sodium or retention of potassium (8); and disturbances in metabolism or carbohydrate (9). Since it seems, at present, bootless to attempt to relate the anomalies in carbohydrate metabolism to the disturbances in metabolism of water and electrolyte, this aspect of the function of the adrenal cortex will not be discussed. The present investigation was undertaken to determine by tissue analyses the actual distribution of water and electrolyte in the tissues of adrenalectomized rats in relation to the toxic action of potassium and the therapeutic effect of sodium salts. EXPERIMENTAL PROCEDURE Healthy male albino rats weighing approximately 200 grams were adrenalectomized under ether anesthesia via the usual lumbar route. The majority of the animals were fed a low potassium diet of the following composition: lactalbumin 15 per cent, sucrose 25 per cent, dextrin 32 per cent, crisco 22 per cent, cod liver oil 1 per cent, yeast powder 2 per cent, bone ash 2 per cent and NaCl 1 per cent. One group of animals was fed a ration containing 1.5 grams of K,HPO, per 100 grams of the above diet. Diet 1 on analysis, was found to contain 0.03 per cent potassium whereas Diet 2 contained 0.7 per cent potassium. The animals were given distilled water, and the food and water intakes were measured daily.The adrenalectomized animals were divided into groups and treated as follows. The animals of the first group were sacrificed when symptoms of severe adrenal insufficiency were manifest. The time of onset of symptoms was exceedingly variable on Diet 1 so that the rats could not be sacrificed at stated intervals after operation if comparable results were to be obtained. Immediately after sacrificing the animals, the livers were removed and a sample of muscle was dissected off rapidly and freed of fat and connective tissue. The skin was removed in toto and the remainder of the carcass treated separately. All of the tissues were put into covered receptacles, weighed and then placed in an oven at 105°C. and dried until constant weight was attained.The dried tissues were ground to a powder in a small food chopper. The dried powdered tissues were kept in glass stoppered flasks and aliquots taken for analysis.One cubic centimeter samples of serum were accurately weighed in platinum dishes and the water content obtained by drying 24 hours in an oven at 1050 C. The dried residue was ashed in a furnace at 5000 C. for 2 hours.Serum chloride was determined by the method of Van Slyke and Sendroy (10). The tissue chloride was determined after ashing the material at 4500 C. in the presence of a large excess of sodium carbonate. Th...

show abstract

“…The 11-oxygenated adrenal steroids were shown to have their effect on carbohydrate metabolism resulting in a sparing of glucose and an increase in glucose production (195). The glucocorticoids, which are activated during stress, may impair the immunologic response at each stage from the initial interaction and processing of the antigens by the cells of the reticuloendothelial system through antibody production (18).…”

Section: B Brain-pituitary-adrenal Interactionsmentioning

confidence: 99%