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The adrenal response after severe trauma.
Patrick J Offner1, Ernest E Moore, David Ciesla
1Trauma Service, St. Anthony Central Hospital, 1641 West 16th Ave., Denver, CO 80204, USA. PatOffner@aol.com
American Journal of Surgery
|December 19, 2002
Summary
Occult adrenal insufficiency is common after severe trauma, affecting 60% of patients. However, low cortisol levels did not impact mortality in this study of trauma patients.
Area of Science:
- Endocrinology
- Trauma critical care
Background:
- The hypothalamic-pituitary-adrenal (HPA) axis regulates the stress response.
- Relative adrenal insufficiency is linked to poor outcomes in critical illness, but its role is debated.
- The study investigated cortisol response and adrenal insufficiency after severe trauma.
Purpose of the Study:
- To prospectively evaluate cortisol response in severely injured patients.
- To determine the incidence of occult adrenal insufficiency post-trauma.
- To assess the relationship between adrenal insufficiency and patient outcomes.
Main Methods:
- Prospective study of 22 severely injured patients in a surgical intensive care unit.
- Measurement of random serum cortisol levels on days 0, 5, and 10 post-injury.
- Definition of relative adrenal insufficiency as serum cortisol < 18 microg/dL.
Main Results:
- Mean baseline cortisol levels were elevated (35 ± 3 microg/dL) and declined over 10 days.
- 60% (13/22) of patients exhibited occult adrenal insufficiency (cortisol < 18 microg/dL).
- Adrenal insufficiency did not correlate with mortality in this cohort.
Conclusions:
- Severe trauma causes an initial increase in cortisol, followed by a return to normal levels.
- Occult adrenal insufficiency is prevalent in severely injured patients.
- The impact of occult adrenal insufficiency on mortality requires further investigation.