[Stress, allostasis and organ failure : On the 90th anniversary of the first description of the "general adaptation syndrome"].

A groundbreaking paper by the endocrinologist Hans Selye was published in Nature 90 years ago in which he developed a comprehensive theory of the g adaptation syndrome in organisms responding to harmful stimuli. Selye observed stereotypical hormonal reactions in rats subjected to a wide variety of physical and chemical irritants and later on introduced the now ubiquitous term "stress" to describe these phenomena. He borrowed the term from physics (stress and strain), where it describes the deformation of a solid body by applied forces. Selye later conceded that in a biomedical context, it would have been more accurate to use the effects of stress, i.e., strain, to describe the general adaptation syndrome rather than the triggering factors. Analogous to overstretching a solid until it fractures, exceeding the repair and defence systems of living organisms leads to a point of no return, characterized by organ damage and ultimately death. Selye's research has fundamentally contributed to our understanding of injury responses particularly in intensive care medicine. For example, trauma-induced stress effects in surgical patients can be successfully modulated through analgesia and sedation. This review aims to explain the advances in medical stress research, particularly the concepts of allostasis and hormesis and their underlying molecular mechanisms for medical actions, using the paradigm of organ failure in sepsis as an example.