Effect of physical stressors on neuroendocrine response in critically ill patients
https://doi.org/10.1234/YMJ.2022.77.25
Abstract
A critical condition is a complex of changes that require replacement of the functions of vital organs and systems to prevent death. The set of reactions can be considered as a gradual development of physiological and pathological reactivity. The most important role in the formation of reactivity in critical conditions is played by the neuroendocrine and neuroimmune systems. The concept of the neuroendocrine system includes connections between the endocrine and central nervous systems and their relationship in the control of homeostasis. Stimulation of the immune system to a complex neuroimmunoendocrine interaction in order to avoid development of a critical condition. Cytokines and afferent pathways of the vagus nerve activate the hypothalamic-pituitary-adrenal system, as a result of which the increased secretion of glucocorticoids suppresses the activity of the immune system. The main action of thyroid hormones is manifested at the genomic level by stimulating the synthesis of many structural proteins of the body and suppressing the expression of neuronal NOS. The sympathetic link of the autonomic nervous system leads to a decrease in the release of pro-inflammatory cytokines, while the synthesis of anti-inflammatory cytokines does not change. In turn, glucocorticoids have a powerful anti-inflammatory effect by reducing the transcription of cytokines by suppressing the nuclear factor "kappa-bi" - a universal transcription factor that controls the expression of genes for the immune response, apoptosis and the cell cycle. At the same time, in critical conditions, a high level of cortisol is observed against the background of a suppressed level of ACTH. This fact is explained by glucocorticoid resistance.
The relationship between the immune system and the central nervous system when exposed to stressors leads to stereotyped responses that include autonomic, endocrine and behavioral components. But despite the extremely important role of neuroendocrine factors in the implementation of critical conditions, their significance, as well as indications and measures of influence on them, have not yet been studied in detail. Further study and the concept of endocrinopathies of critical conditions in the future will be the basis for assessing the endocrine status in order to resolve the issue of the need for substitution therapy.
About the Authors
N. E. Altshuller
АО «Европейский медицинский центр»
Russian Federation
Russian Federation
Natavan E. Altshuller – MD, endocrinologist, anesthesiologist.
Moscow
E. I. Aleschenko
АО «Европейский медицинский центр»
Russian Federation
Russian Federation
Elena I. Aleschenko – MD, anesthesiologist and intensive care specialist, head of the department.
Moscow
M. B. Kutcyi
АО «Европейский медицинский центр»
Russian Federation
Russian Federation
Mikhail B. Kutcyi – MD, anesthesiologist, supervisor of the operation center.
Moscow
N. M. Kruglyakov
State Scientific Research Center of the Russian Federation, Burnazyan Federal Medical Biophysical Centre of Federal Medical Biological Agency
Russian Federation
Russian Federation
Nikolay M. Kruglyakov – anesthesiologist, head of the department, the State Scientific Research Center of the Russian Federation, Burnazyan Federal Medical Biophysical Centre of Federal Medical Biological Agency.
Moscow
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For citations:
Altshuller N.E., Aleschenko E.I., Kutcyi M.B., Kruglyakov N.M. Effect of physical stressors on neuroendocrine response in critically ill patients. Yakut Medical Journal. 2022;(1):99-104. https://doi.org/10.1234/YMJ.2022.77.25
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