The Adrenocortical Response to Extensive Burns in Man*

Wilson, Harwell; Lovelace, John R.; Hardy, James D.

doi:10.1097/00000658-195502000-00002

Cited by 23 publications

(5 citation statements)

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“…One of the integral components of this stress response is the activation of the adrenal axis resulting in an exaggerated output of cortisol. A number of studies have demonstrated increases in total plasma cortisol and adrenocorticotrophic hormone (ACTH) concentrations in the days following thermal injury [ 1 - 3 ]. Urinary free cortisol levels have also been shown to be increased after burns for up to 100 days [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

et al. 2009

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IntroductionThe assessment of adrenal function in critically ill patients is problematic, and there is evidence to suggest that measurement of tissue glucocorticoid activity may be more useful than estimation of plasma cortisol concentrations. Interstitial cortisol concentrations of cortisol represent the available pool of glucocorticoids able to enter the cell and bind to the glucocorticoid receptor. However the concentrations of plasma cortisol may not accurately reflect interstitial concentrations. We elected to perform a preliminary study into the feasibility of measuring interstitial cortisol by microdialysis, and to investigate the relationship between total plasma cortisol, free plasma cortisol and interstitial cortisol in patients with severe burns.MethodsA prospective observational study carried out in a tertiary intensive care unit. Ten adult patients with a mean total burn surface area of 48% were studied. Interstitial cortisol was measured by microdialysis from patient-matched burnt and non-burnt tissue and compared with that of 3 healthy volunteers. Plasma sampling for estimations of total and free cortisol concentrations was performed concurrently.ResultsIn the burn patients, mean total plasma and free plasma cortisol concentrations were 8.8 +/- 3.9, and 1.7 +/- 1.1 mcg/dL, (p < 0.001), respectively. Mean subcutaneous microdialysis cortisol concentrations in the burn and non-burn tissue were 0.80 +/- 0.31 vs 0.74 +/- 0.41 mcg/dL (p = 0.8), respectively, and were significantly elevated over the mean subcutaneous microdialysis cortisol concentrations in the healthy volunteers. There was no significant correlation between total plasma or free plasma and microdialysis cortisol concentrations. Plasma free cortisol was better correlated with total burn surface area than total cortisol.ConclusionsIn this preliminary study, interstitial cortisol concentrations measured by microdialysis in burnt and non-burnt skin from patients with severe thermal injury are significantly elevated over those from healthy volunteers. Plasma estimations of cortisol do not correlate with the microdialysis levels, raising the possibility that plasma cortisol may be an unreliable guide to tissue cortisol activity.

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Section: Introductionmentioning

confidence: 99%

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

et al. 2009

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“…c-Fos and c-Jun, which are two key components of the AP-1 transcription complex, are among those molecules that respond rapidly and transiently. Sequential release of corticotropin releasing hormone and ACTH from the HPA axis in response to burn stress will, in turn, rapidly stimulate synthesis and release of glucocorticoids from the adrenal cortex, mainly zona fasciculata cells [3,19]. It has been reported that c-Fos and Jun B mRNAs are induced when ACTH was applied to cultured bovine adrenal fasciculata cells [20].…”

Section: Discussionmentioning

confidence: 99%

CD14- and Toll-Like Receptor 4-Dependent Regulation of c-Fos, c-Jun and c-Jun Phosphorylation in the Adrenal Gland afterBurn Injury

et al. 2004

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Objectives: Although the pathophysiology of the adrenocortical response after injury has been described, alterations in the molecular profile (e.g. transcription factors) of the adrenal gland itself are not well understood. The regulation of c-Fos, c-Jun, and c-Jun phosphorylation in the adrenal gland after burn injury was investigated in this study. In addition, since burn injury is often associated with lipopolysaccharide (LPS)-mediated sepsis, we examined the involvement of the LPS signaling pathway in the regulation of these transcription factors utilizing CD14 knockout and C3H/HeJ (encoding defective toll-like receptor 4) mice. Methods: Adrenal glands harvested after an 18% total body surface area burn were subjected to RT-PCR and Western blot analyses of c-Jun and c-Fos. Results: There was a rapid induction of c-Jun and c-Fos expression (mRNA and protein), and c-Jun serine phosphorylation. The induction of c-Jun and its phosphorylation after injury was greater in CD14 knockout and C3H/HeJ mice compared to their respective controls. A similar pattern was observed in the c-Fos regulation. Conclusions: These data suggest that c-Fos and c-Jun are activated in the adrenal gland in response to burn injury. In addition, an LPS-mediated signaling pathway may influence the regulation of these transcription factors after injury.

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“…Of particular interest is the parallelism of the adrenocortical response to the burn trauma and the increase of the excretion of amino acids. The amounts of the corticoids excreted are usually high immediately after the burn and return to a normal value upon recovery (4). This increase in urinary corticoids may in part account for some of the bound glycine excreted (8) the gly-cine being bound in some fashion to the steroid.…”

Section: Discussionmentioning

confidence: 99%

“…The details of studies on these patients, other than the amino acid excretion studies, appear elsewhere. Description of each patient included in this report has already been published (4).…”

Section: Methodsmentioning

confidence: 99%

Thermal Burns in Man. Ix. Urinary Amino Acid Patterns 1

Eades¹,

Pollack²,

Hardy³

1955

J. Clin. Invest.

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It is a well known phenomenon that burned patients lose considerable amounts of nitrogenous materials following the initial trauma. They continue to stay in negative nitrogen balance for several days or even a month or more despite efforts to supply quantities of the necessary amino acids for metabolism and repair. Even though much protein material is lost in exudates (1), considerable amounts of catabolic nitrogenous substances appear in the urine. Besides the urea, creatinine, uric acid, and ammonia, relatively large amounts of amino acids and amino acid derivatives are excreted. This increase in the loss of amino acids is of special interest since it represents, for the most part, a wastage of materials needed for replacement and repair of the injured tissue.In a recent paper Nardi (2) has studied the excretion of the free amino acids in urine of the burned patient by qualitative paper chromatographic techniques. In the study reported here, the quantitative determination of the amounts of 16 amino acids excreted in the urine following burn trauma has been studied in 9 patients to define with more exactness the qualitative and the quantitative aspects of the amino acid loss. In order to determine with greater clarity the amino acid patterns in urines of these burned patients, the amount of "free" amino acid and the "total" amount of each amino acid were determined. METHODSPatients with burns involving more than 15 per cent of the body surface were examined in the emergency ward by the burn study team and then admitted to the metabolic ward where initial clinical measurements were made. The patients were then placed on a program of fluid therapy approximating that suggested by Evans, Purnell, Robinett, Batchelor, and Martin (3). This consistent policy was required to permit comparison among patients. The details of studies on these patients, other than the amino acid excretion studies, appear elsewhere. Description of each patient included in this report has already been published (4).As soon as was feasible, usually about 48 hours following admission to the hospital, the patient was placed on a standardized liquid oral diet. It was of known content both as to quality and quantity of the various components. Amino acids were supplied in the diet as whole natural protein. This standard diet procedure was used in order to eliminate any metabolic variations in the excretion of amino acids that might occur from variations in the quantity or quality of the amino acid source ingested.The patient was continued on the diet for at least four days. Complete urine collections were made and an aliquot of the collection on the fourth day of the diet was analyzed for the amino acid content. During late convalescence from the burn, usually just prior to discharge from the hospital, the diet was again administered to five of the nine patients for four days and urines again collected. On several occasions the patients were readmitted to the hospital for these latter studies. Thus in a measure the patient served as his own contr...

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The Adrenocortical Response to Extensive Burns in Man*

Cited by 23 publications

References 4 publications

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

CD14- and Toll-Like Receptor 4-Dependent Regulation of c-Fos, c-Jun and c-Jun Phosphorylation in the Adrenal Gland afterBurn Injury

Thermal Burns in Man. Ix. Urinary Amino Acid Patterns 1

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