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Anomalies endocriniennes en réanimation

  • A. Roquilly
  • K. Asehnoune
Part of the Le point sur ... book series (POINT)

Résumé

Les patients atteints d’un choc septique, d’un polytraumatisme ou de toute autre pathologie aiguë mettant en jeu le pronostic vital vont développer des défaillances d’organe même si ceux-ci n’ont pas été directement lésés lors du stress initial. Ces défaillances sont traditionnellement attribuées aux effets de médiateurs pro-inflammatoires qui induisent des changements macro- et microcirculatoires responsables d’hypoxie tissulaire et de dégâts cellulaires. Cependant, si les choses étaient aussi simples, ces défaillances d’organe devraient être irréversibles, notamment pour les organes á faible capacité de régénération tels que le rein. En fait, si l’insuffisance rénale nécessite fréquemment un support par épuration extrarénale, elle évolue á long terme vers une restitution « ad integrum » de la fonction rénale quand le patient survit. Il est également remarquable que les organes lésés fonctionnellement restent quasiment normaux histologiquement, notamment en termes d’architecture et de structure tissulaire avec très peu de phénomènes apoptotiques ou de nécrose cellulaire. Ces constatations plaident en faveur d’une atteinte fonctionnelle plus que structurelle des organes. Les cellules entrent dans un état d’hibernation qui permet de préserver l’organe en altérant certes sa fonction (1). Cet état « d’endormissement métabolique » est directement attribué á la réponse inflammatoire ainsi qu’á la réponse neuro-endocrine qui sont toutes deux fortement intriquées.

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Copyright information

© Springer-Verlag France 2011

Authors and Affiliations

  • A. Roquilly
  • K. Asehnoune

There are no affiliations available

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