Adrenal Cortical Function in Severe Burns

Wise, Leslie; Margraf, Harry W.; Ballinger, Walter F.

doi:10.1001/archsurg.1972.04180080067012

Cited by 28 publications

(8 citation statements)

References 17 publications

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“…6,7 Burn patients are subjected not only to the stress of large open wounds and dressing changes but also to multiple surgeries, mechanical ventilation, metabolic derangements, sleep deprivation, and infections throughout their hospitalization. These stressors result in a nearcontinuous demand on the HPA axis for a prolonged period of time which, as demonstrated in this study, alters the stress response.…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic–Pituitary–Adrenal Axis Response to Sustained Stress after Major Burn Injury in Children

Palmieri¹,

Levine²,

Schonfeld-Warden³

et al. 2006

Journal of Burn Care & Research

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The hypothalamic-pituitary-adrenal (HPA) axis is responsible for stress response after injury, yet its function after severe burn injury in children is unclear. The purpose of this study was to define the effects of burn injury on the HPA axis and to evaluate the utility of total serum cortisol in measuring adrenal function in children with major burns in the 2 months after injury. Children ages 0 to 17 years who were admitted within 72 hours to our pediatric burn center with 20% TBSA or greater full-thickness burns were eligible for the study. Serum total cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone, vasopressin, Pediatric Risk of Mortality (PRISM) score, serum albumin level, and electrolytes were obtained on admission and weekly for 8 weeks. An ACTH stimulation test (250 microg for children >2 years, 125 microg for children < or =2 years) was administered weekly at 8:00 am. Total serum cortisol was measured before and 60 minutes after the administration of ACTH. Twenty-five children with mean age 7.6 +/- 1.1 years and TBSA burn 41.8 +/- 3.8% were enrolled in the study. Baseline total serum cortisol was 12.4 +/- 0.7 microg/dl in the 8 weeks after injury and increased to 24.4 +/- 0.8 microg/dl after the administration of ACTH. Cortisol level did not correlate with PRISM score, albumin, vasopressin, ACTH, or mortality. Although the adrenal response to acute and chronic stress is intact after severe burn injury, the ACTH/adrenal feedback loop is disrupted. Random total serum cortisol measurements overestimate adrenal dysfunction; thus, ACTH stimulation testing should be used to assess adrenal function before the administration of exogenous steroids.

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Section: Discussionmentioning

confidence: 99%

Hypothalamic–Pituitary–Adrenal Axis Response to Sustained Stress after Major Burn Injury in Children

Palmieri¹,

Levine²,

Schonfeld-Warden³

et al. 2006

Journal of Burn Care & Research

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“…Early reports have demonstrated a decrease in serum CBG binding capacity of burn patients [45,46] together with increased circulating cortisol. It is not clear from these observations whether CBG binding capacity or CBG concentration, or both, were involved in the de creased capacity of the sera of these patients to bind corti sol.…”

Section: Cbg In Burn Injurymentioning

confidence: 99%

Corticosteroid-Binding Globulin during Inflammation and Burn Injury: Nutritional Modulation and Clinical Implications

Garrel¹

1996

Horm Res

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Corticosteroid-binding globulin (CGB) is the main carrier of glucocorticoids in mammals. Serum CBG shows little physiological variation with the exception of pregnancy. Experimental inflammation and burn injury decrease serum CBG in rats and while the mechanism of this effect is unknown, in vitro experiments suggest that interleukin-6 may be involved. In severely burned patients, we have found that CBG was markedly decreased within a few hours postinjury. This decrease lasted about 2 weeks and was accompanied by an increase in the free fraction of serum cortisol. In addition, serum CBG responded to dietary manipulation in these patients, with low fat feeding resulting in higher serum CBG concentrations and lower serum-free cortisol values. This finding suggests that during severe stress, CBG may be important in regulating the amount of cortisol reaching target tissues such as the immune system and wounds.

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“…The pattern of cortisol release also contrasts with those reported for adults. Although high at admission, cortisol concentrations were down to within normal range by 24 h, but in adults high cortisol levels persisted over longer periods of time ( Wise et al ., 1972 ; Vaughan et al ., 1982 ; Jeffries et al ., 1992 ). Our data also differ from those of Popp et al .…”

Section: Discussionmentioning

confidence: 99%

The systemic stress response to thermal injury in children

Sedowofia

Barclay

Quaba

et al. 1998

Clinical Endocrinology

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Thermal injury results in the release of abnormally high levels of stress hormones in children. Although there are similarities between some of the data reported here and those reported in adults, higher levels of adrenaline and lower levels of noradrenaline than reported in adults suggest important differences too. These differences may need to be taken into account in the management of burn-injured children.

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Adrenal Cortical Function in Severe Burns

Cited by 28 publications

References 17 publications

Hypothalamic–Pituitary–Adrenal Axis Response to Sustained Stress after Major Burn Injury in Children

Hypothalamic–Pituitary–Adrenal Axis Response to Sustained Stress after Major Burn Injury in Children

Corticosteroid-Binding Globulin during Inflammation and Burn Injury: Nutritional Modulation and Clinical Implications

The systemic stress response to thermal injury in children

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