Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is responsible for stress response after injury, yet its function after severe burn injury in children is unclear. The purpose of this study was to define the effects of burn injury on the HPA axis and to evaluate the utility of total serum cortisol in measuring adrenal function in children with major burns in the 2 months after injury. Children ages 0 to 17 years who were admitted within 72 hours to our pediatric burn center with 20% TBSA or greater full-thickness burns were eligible for the study. Serum total cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone, vasopressin, Pediatric Risk of Mortality (PRISM) score, serum albumin level, and electrolytes were obtained on admission and weekly for 8 weeks. An ACTH stimulation test (250 μg for children >2 years, 125 μg for children ≤2 years) was administered weekly at 8:00 am. Total serum cortisol was measured before and 60 minutes after the administration of ACTH. Twenty-five children with mean age 7.6 ± 1.1 years and TBSA burn 41.8 ± 3.8% were enrolled in the study. Baseline total serum cortisol was 12.4 ± 0.7 μg/dl in the 8 weeks after injury and increased to 24.4 ± 0.8 μg/dl after the administration of ACTH. Cortisol level did not correlate with PRISM score, albumin, vasopressin, ACTH, or mortality. Although the adrenal response to acute and chronic stress is intact after severe burn injury, the ACTH/adrenal feedback loop is disrupted. Random total serum cortisol measurements overestimate adrenal dysfunction; thus, ACTH stimulation testing should be used to assess adrenal function before the administration of exogenous steroids.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 742-748 |
| Number of pages | 7 |
| Journal | Journal of Burn Care and Research |
| Volume | 27 |
| Issue number | 5 |
| DOIs | |
| State | Published - Sep 2006 |
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ASJC Scopus subject areas
- Emergency Medicine
- Rehabilitation
- Surgery
Cite this
Hypothalamic-pituitary-adrenal axis response to sustained stress after major burn injury in children. / Palmieri, Tina L; Levine, Seymour; Schonfeld-Warden, Nancy; O'Mara, Michael S.; Greenhalgh, David G.
In: Journal of Burn Care and Research, Vol. 27, No. 5, 09.2006, p. 742-748.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Hypothalamic-pituitary-adrenal axis response to sustained stress after major burn injury in children
AU - Palmieri, Tina L
AU - Levine, Seymour
AU - Schonfeld-Warden, Nancy
AU - O'Mara, Michael S.
AU - Greenhalgh, David G
PY - 2006/9
Y1 - 2006/9
N2 - The hypothalamic-pituitary-adrenal (HPA) axis is responsible for stress response after injury, yet its function after severe burn injury in children is unclear. The purpose of this study was to define the effects of burn injury on the HPA axis and to evaluate the utility of total serum cortisol in measuring adrenal function in children with major burns in the 2 months after injury. Children ages 0 to 17 years who were admitted within 72 hours to our pediatric burn center with 20% TBSA or greater full-thickness burns were eligible for the study. Serum total cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone, vasopressin, Pediatric Risk of Mortality (PRISM) score, serum albumin level, and electrolytes were obtained on admission and weekly for 8 weeks. An ACTH stimulation test (250 μg for children >2 years, 125 μg for children ≤2 years) was administered weekly at 8:00 am. Total serum cortisol was measured before and 60 minutes after the administration of ACTH. Twenty-five children with mean age 7.6 ± 1.1 years and TBSA burn 41.8 ± 3.8% were enrolled in the study. Baseline total serum cortisol was 12.4 ± 0.7 μg/dl in the 8 weeks after injury and increased to 24.4 ± 0.8 μg/dl after the administration of ACTH. Cortisol level did not correlate with PRISM score, albumin, vasopressin, ACTH, or mortality. Although the adrenal response to acute and chronic stress is intact after severe burn injury, the ACTH/adrenal feedback loop is disrupted. Random total serum cortisol measurements overestimate adrenal dysfunction; thus, ACTH stimulation testing should be used to assess adrenal function before the administration of exogenous steroids.
AB - The hypothalamic-pituitary-adrenal (HPA) axis is responsible for stress response after injury, yet its function after severe burn injury in children is unclear. The purpose of this study was to define the effects of burn injury on the HPA axis and to evaluate the utility of total serum cortisol in measuring adrenal function in children with major burns in the 2 months after injury. Children ages 0 to 17 years who were admitted within 72 hours to our pediatric burn center with 20% TBSA or greater full-thickness burns were eligible for the study. Serum total cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone, vasopressin, Pediatric Risk of Mortality (PRISM) score, serum albumin level, and electrolytes were obtained on admission and weekly for 8 weeks. An ACTH stimulation test (250 μg for children >2 years, 125 μg for children ≤2 years) was administered weekly at 8:00 am. Total serum cortisol was measured before and 60 minutes after the administration of ACTH. Twenty-five children with mean age 7.6 ± 1.1 years and TBSA burn 41.8 ± 3.8% were enrolled in the study. Baseline total serum cortisol was 12.4 ± 0.7 μg/dl in the 8 weeks after injury and increased to 24.4 ± 0.8 μg/dl after the administration of ACTH. Cortisol level did not correlate with PRISM score, albumin, vasopressin, ACTH, or mortality. Although the adrenal response to acute and chronic stress is intact after severe burn injury, the ACTH/adrenal feedback loop is disrupted. Random total serum cortisol measurements overestimate adrenal dysfunction; thus, ACTH stimulation testing should be used to assess adrenal function before the administration of exogenous steroids.
UR - http://www.scopus.com/inward/record.url?scp=33749005926&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33749005926&partnerID=8YFLogxK
U2 - 10.1097/01.BCR.0000238098.43888.07
DO - 10.1097/01.BCR.0000238098.43888.07
M3 - Article
C2 - 16998409
AN - SCOPUS:33749005926
VL - 27
SP - 742
EP - 748
JO - Journal of Burn Care and Research
JF - Journal of Burn Care and Research
SN - 1559-047X
IS - 5
ER -