Figure 1

Activation of the hypothalamic–pituitary–adrenal axis during acute stress. Activating effects are shown with plain arrows, and inhibitory effects with dotted arrows. The round symbols indicate the potential mechanisms that are involved in the axis dysfunction that occurs during sepsis either by failure of production or by tissue resistance to glucocorticoids. ACTH, adrenocorticotrophic hormone; AVP, arginine vasopressine; CBG, cortisol-binding globulin; CRH, corticotropin-releasing hormone; GRE, glucocorticoid responsive element; IFN, interferon; IL, interleukin; R, glucocorticoid receptor; ANS, autonomic nervous system; Th, T helper; TNF, tumour necrosis factor.