Is pituitary failure the real therapeutic target in septic shock?

Severe sepsis and septic shock have been part of intensivists' major challenges since the birth of the specialty. This clinical picture is followed by the development of a multiple organ failure syndrome. Our working hypothesis today is that multiple organ failures develop due to a systemic intravascular malignant inflammatory response. This article proposes an alternative understanding of the problem based on some of the recent data and understandings of non glycemic, non insulinemic endocrine dysfunction in severe sepsis and septic shock. Our presentation of selected literature supports the presence of a decreased production and activity in steroids, thyroid hormones, growth hormone, vasopressin and prolactin in septic shock. These hormones have important and synergistic functions. The disruption of which can lead to multiple organ failure in septic shock. Developing research focusing on the broad hypothalamic and pituitary functions could improve our understanding of metabolic derangements in severe sepsis and septic shock and thus provide new therapeutic options. These new therapies based on hormonal replacement are currently available at low cost and could improve outcomes.