Endocrine disruptions in thermal injuries: exploring immune system interactions

Burn injuries are among the most devastating disruptors of human physiology, provoking systemic disturbances unmatched by nearly any other form of pathology, yet they remain critically underappreciated. Each year, approximately 8.4 million people sustain burn injuries worldwide, leading to 110,000 deaths and countless cases of long-term disability. Beyond the immediate tissue damage, burns trigger a uniquely severe and persistent hypermetabolic response that, if not effectively managed, cascades into widespread dysfunction across multiple organ systems, driving morbidity and, in many cases, mortality. Among the many affected organ systems is the endocrine system, which, when disrupted, leads to compromised fluid and mineral balance, cachexia, insulin resistance, immunosuppression, and various other health issues. In this narrative literature review, we highlight the various endocrine axes and how they are dysregulated by thermal injury and the current pharmacological strategies that are used to treat these burn-induced hormone disruptions and hypermetabolism. Taking into account the widespread effects of the endocrine system, we also delve into the intricate interplay between the endocrine and immune systems of each axis, highlighting the substantial challenge of immunosuppression often observed in severe burn patients. Additionally, we underline the current gaps that exist in the literature and the urgent need for long-term longitudinal trials that take factors such as age and sex into consideration. A better understanding of the implications of burns on the endocrine system will help with the development of effective treatments that could improve the long-term health of severe burn patients.