You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 127 No. 12, December 1992 TABLE OF CONTENTS
  Archives
  •  Online Features
  BASIC SCIENCE
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

The Hypothalamic-Pituitary-Adrenal—Immune Axis

A Critical Assessment

Michael P. Lilly, MD; Donald S. Gann, MD

Arch Surg. 1992;127(12):1463-1474.


Abstract

• The hypothalamic-pituitary-adrenal (HPA) system has been a model for neuroendocrine control of responses of organisms to stressors since the turn of the century. Despite this, the pathways by which infectious insults interact with the HPA system remained poorly defined. Recently, evidence has been presented suggesting that humoral mediators released by inflammatory cells (cytokines) may participate in two-way communication between the site of inflammation and the central nervous system. In this review, we detail the current understanding of the responses of the HPA system to the classic physiologic stimuli of hypovolemia and pain, with an emphasis on the cellular mechanisms and mediators discovered in recent years. We also examine the data substantiating a role of interleukin 1, interleukin 6, and tumor necrosis factor in the direct humoral activation of the HPA system and consider the evidence favoring a physiologic negative feedback relationship between the HPA and the immune systems. Such an interaction is an exciting concept with broad clinical implications. However, we believe that the temporal and quantitative aspects of experiments designed to evaluate this interaction must be carefully evaluated to assure that true physiologic stimuli are studied and that the responses observed are not due to pharmacologic effects of inflammatory mediators acting through "classic" neuroendocrine pathways.

(Arch Surg. 1992;127:1463-1474)



Author Affiliations

From the Department of Surgery, University of Maryland, Baltimore.


Footnotes

Accepted for publication April 12, 1992.

Reprint requests to Department of Surgery, University of Maryland, 22 South Greene St, Baltimore, MD 21201 (Dr Lilly).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Testosterone receptor blockade after trauma and hemorrhage attenuates depressed adrenal function
Ba et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2000;279:R1841-R1848.
ABSTRACT | FULL TEXT  

Hyperbaric oxygen treatment attenuates cytokine induction after massive hemorrhage
Yamashita and Yamashita
Am. J. Physiol. Endocrinol. Metab. 2000;278:E811-E816.
ABSTRACT | FULL TEXT  

Mechanism of Adrenal Insufficiency Following Trauma and Severe Hemorrhage: Role of Hepatic 11{beta}-Hydroxysteroid Dehydrogenase
Wang et al.
Arch Surg 1999;134:394-401.
ABSTRACT | FULL TEXT  

Responses of hepatic TNF-alpha mRNA to repeated hemorrhage in the conscious rat
Yamashita and Yamashita
Am. J. Physiol. Endocrinol. Metab. 1998;275:E27-E31.
ABSTRACT | FULL TEXT  

Polymyxin B Prevents Increased Sympathetic Activity and Alveolar Macrophage Tumor Necrosis Factor Release in Parenterally Fed Rats
Johnson et al.
Arch Surg 1995;130:1294-1300.
ABSTRACT  

TPN-Induced Sympathetic Activation Is Related to Diet, Bacterial Translocation, and an Intravenous Line
Helton et al.
Arch Surg 1995;130:209-214.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1992 American Medical Association. All Rights Reserved.