Related Experiment Video

Updated: Jul 19, 2026

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents
06:15

A Modified Trier Social Stress Test for Vulnerable Mexican American Adolescents

Published on: July 10, 2017

Hypothalamic-pituitary-adrenal axis response to sustained stress after major burn injury in children

Tina L Palmieri1, Seymour Levine, Nancy Schonfeld-Warden

  • 1Shriners Hospital for Children Northern California, University of California, Sacramento, California 95817, USA.

Journal of Burn Care & Research : Official Publication of the American Burn Association
|September 26, 2006
PubMed

Insights

Severe pediatric burn injuries disrupt the hypothalamic-pituitary-adrenal (HPA) axis, affecting stress response. ACTH stimulation tests are crucial for accurate adrenal function assessment post-burn.

Area of Science:

  • Pediatric Endocrinology
  • Trauma and Burn Care
  • Endocrinology

Background:

  • The hypothalamic-pituitary-adrenal (HPA) axis regulates stress response, but its function post-severe pediatric burn injury remains unclear.
  • Understanding HPA axis dynamics is vital for managing pediatric burn patients.

Purpose of the Study:

  • To define the impact of severe burn injury on the pediatric HPA axis.
  • To evaluate the effectiveness of total serum cortisol measurements in assessing adrenal function in pediatric burn patients.

Main Methods:

  • Prospective study of pediatric patients (0-17 years) with ≥20% TBSA full-thickness burns.
  • Weekly measurements of serum cortisol, ACTH, and other biomarkers for 8 weeks.
  • Weekly ACTH stimulation tests to assess adrenal response.

Main Results:

  • Baseline serum cortisol was 12.4 μg/dL, increasing to 24.4 μg/dL post-ACTH stimulation.
  • Cortisol levels did not correlate with PRISM score, albumin, ACTH, vasopressin, or mortality.
  • The adrenal response to stress is intact, but the ACTH/adrenal feedback loop is disrupted.

Conclusions:

  • Random total serum cortisol measurements can overestimate adrenal dysfunction in pediatric burn patients.
  • ACTH stimulation testing is the recommended method for evaluating adrenal function before administering exogenous steroids.

More Related Videos

Restraint to Induce Stress in Mice and Rats03:48

Restraint to Induce Stress in Mice and Rats

Published on: December 6, 2024

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment08:25

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Published on: December 6, 2024

Related Concept Videos

Hypothalamic-Pituitary Axis01:37

Hypothalamic-Pituitary Axis

The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
Physiological Foundation of Stress01:24

Physiological Foundation of Stress

Stress triggers a coordinated physiological response involving the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis. This dual activation ensures that the body is prepared for both immediate and prolonged stress management. The process begins with the perception of a stressor. This initial phase activates the SNS, leading to the rapid release of adrenaline (epinephrine) from the adrenal glands.
Role of the Sympathetic Nervous System
Adrenaline triggers the...
Stress Response System01:21

Stress Response System

The stress response system, also known as the fight-or-flight response, is the body's automatic physiological reaction to perceived threats. Hans Selye introduced the concept of General Adaptation Syndrome (GAS) to describe the predictable pattern of changes that occur in response to stress. GAS consists of three sequential stages: alarm, resistance, and exhaustion. This model helps explain how chronic stress can contribute to health problems.
Alarm stage
In the alarm stage, the body's initial...
Cushing Syndrome II: Pathophysiology01:19

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
Introduction to Stress and Lifestyle01:27

Introduction to Stress and Lifestyle

Stress is a multifaceted response to events perceived as challenging or threatening, highlighting physical, emotional, cognitive, and behavioral reactions. Physically, stress can lead to fatigue, sleep disruptions, and various health issues such as frequent colds, chest pains, and nausea. Emotionally, it can manifest as anxiety, depression, irritability, and anger triggered by both minor and major life events. Cognitively, it may result in difficulty in concentration, memory, and...
Cushing Syndrome I: Introduction01:26

Cushing Syndrome I: Introduction

Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...