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October, 1959 HYPOTENSION WITH ANESTHESIA—CRANDELL AND WHITCHER Hypothalamic - Pituitary - Adrenocortical System 417 Posterior ; CORTICOTROPIN Anterior ADRENAL CORTEX PITUITARY HYPOTHALAMUS rmH'!"!' A ADRENAL MEDULLA SURGERY Figure 1 sone and corticotropin in recent years has increased the incidence of acute adrenocortical insufficiency when the patient is subjected to the stress of surgery. The adrenocorticotropic hormone of the anterior pituitary gland is released in response to a variety of stressful situations and stimuli (fig. 1). The adrenocortical steroids are secreted in response to stimulation of the adrenal cortex by the adrenocorticotropic hormone. The hypothalmic-pituitary-adren-al axis may be activated from the site of stress via sympathetic fibers to the adrenal medulla, resulting in the release of epinephrine. The increased concentration of epinephrine in the systemic circulation results in the release from the hypothalmus of a humoral substance that stimulates the anterior pituitary gland to secrete adrenocorticotropic hormone. A decrease in the blood level of adrenocortical steroids also results in the release of adrenocorticotropin by a feedback mechanism. Maximal adrenocorticotropin stimulation of the adrenal cortex produces approximately 10 mg. of hydrocortisone per hour. The administration of cortisone or corticotropin increases the plasma concentration of corticosteroids and depresses the endogenous production of corticotropin. Prolonged therapy leads^ to atrophy and a diminution of adrenocortical function, and can result in the inability of the anterior pituitary gland to secrete adrenocorticotropic hormone in response to stress. A state of relative adrenocortical insufficiency results, even though the adrenal cortex is functionally capable of responding to exogenous corticotropic stimulation. If exogenous corticotropic therapy is discontinued suddenly, a lag phase of approximately one week occurs before the pituitary-adrenocortical system recovers. After several weeks of therapy with cortisone, hydrocortisone, or their derivatives, the lag phase may be as long as six weeks to a year. The reason for this difference is that the corticosteroids suppress the adrenal cortex as well as the pituitary gland. During the lag phase a state of relative adrenocortical insufficiency exists.
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-Present] |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1959 |
Identifier | NCHH-17-020 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 20 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-020.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-020 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
Description
Fixed Title * | Page 417 (image) |
Document Title | North Carolina Medical Journal [1940-Present] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1959 |
Identifier | NCHH-17-020-0575 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed201959medi_0575.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 20 |
Issue Number | 10 |
Page Number | 417 |
Health Discipline | Medicine |
Full Text | October, 1959 HYPOTENSION WITH ANESTHESIA—CRANDELL AND WHITCHER Hypothalamic - Pituitary - Adrenocortical System 417 Posterior ; CORTICOTROPIN Anterior ADRENAL CORTEX PITUITARY HYPOTHALAMUS rmH'!"!' A ADRENAL MEDULLA SURGERY Figure 1 sone and corticotropin in recent years has increased the incidence of acute adrenocortical insufficiency when the patient is subjected to the stress of surgery. The adrenocorticotropic hormone of the anterior pituitary gland is released in response to a variety of stressful situations and stimuli (fig. 1). The adrenocortical steroids are secreted in response to stimulation of the adrenal cortex by the adrenocorticotropic hormone. The hypothalmic-pituitary-adren-al axis may be activated from the site of stress via sympathetic fibers to the adrenal medulla, resulting in the release of epinephrine. The increased concentration of epinephrine in the systemic circulation results in the release from the hypothalmus of a humoral substance that stimulates the anterior pituitary gland to secrete adrenocorticotropic hormone. A decrease in the blood level of adrenocortical steroids also results in the release of adrenocorticotropin by a feedback mechanism. Maximal adrenocorticotropin stimulation of the adrenal cortex produces approximately 10 mg. of hydrocortisone per hour. The administration of cortisone or corticotropin increases the plasma concentration of corticosteroids and depresses the endogenous production of corticotropin. Prolonged therapy leads^ to atrophy and a diminution of adrenocortical function, and can result in the inability of the anterior pituitary gland to secrete adrenocorticotropic hormone in response to stress. A state of relative adrenocortical insufficiency results, even though the adrenal cortex is functionally capable of responding to exogenous corticotropic stimulation. If exogenous corticotropic therapy is discontinued suddenly, a lag phase of approximately one week occurs before the pituitary-adrenocortical system recovers. After several weeks of therapy with cortisone, hydrocortisone, or their derivatives, the lag phase may be as long as six weeks to a year. The reason for this difference is that the corticosteroids suppress the adrenal cortex as well as the pituitary gland. During the lag phase a state of relative adrenocortical insufficiency exists. |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-020.pdf |
Document Sort | all; nchh-17 |
Article Title | Hypotension Associated With Anesthesia |
Article Author | D. Leroy Crandell; Charles E. Whitcher |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-020 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | keep |
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