Session: OR21-HPA Axis: New Clinical Developments
Room 134 (Moscone Center)
102 severely injured patients (52 military, 50 civilian; mean Injury Severity Score 31 (4-75)) entered a prospective study to characterise the immune, inflammatory and endocrine response to trauma. Blood and 24 hour urine samples were obtained at 24 hours and at 3, 5, 10, 14, 21, 28 days and 2, 3, 4 and 6 months post injury. Muscle thickness (ultrasound) was measured weekly and at 3, 4, 5 and 6 months.
Results: The cortisol:cortisone (F:E) ratio peaked at 15 days, returning to normal after 2 months. Initial DHEA concentrations post injury were lower than healthy controls (p<0.0001), but began to normalise by 4 months. DHEA-Sulphate (DHEAS) concentrations had still not returned to normal by 6 months post injury. The cortisol:DHEAS ratio peaked at 20 days and normalised by 6 months. Initial testosterone concentrations were low (p<0.0001), correlated with DHEAS and DHEA (p<0.0001), and normalised by 3 months. Testosterone and F:E ratio (p<0.0001) correlated with nitrogen excretion, which peaked early at 23 gN.day-1 and dropped below 10 gN.day-1 by week 6. Muscle thickness diminished, plateaued and recovered in phase with nitrogen excretion (p<0.0001). Muscle thickness reduced by 31% at 6 weeks, recovering by 5 months.
The Cortisol/DHEA imbalance was temporally associated with a catabolic state in severe trauma. Anabolic hormone recovery reversed catabolism and was strongly associated with testosterone levels. We postulate that anabolic hormones and DHEA could have a therapeutic role in mitigating the catabolic response to severe trauma.
Nothing to Disclose: MF, NH, AAR, CB, DMO, JFB, MMM, JLF, JML
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters