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J Accid Emerg Med. 1996 July; 13(4): 243–247.
PMCID: PMC1342721

Stress hormones in accident patients studied before admission to hospital.

Abstract

OBJECTIVE: To assess stress hormone response in traumatised patients studied at the site of injury and on their way to hospital. METHODS: The study was prospective. Blood samples were taken from 77 patients immediately after the arrival of the emergency physician at the site of the accident (t1) and shortly before patients' admission to hospital (t2). Plasma concentrations of beta endorphin, cortisol, adrenocorticotrophic hormone (ACTH), prolactin, and growth hormone were measured. RESULTS: Trauma in out-of-hospital patients resulted in remarkably increased concentration of growth hormone within minutes. ACTH, cortisol, and prolactin were only moderately increased. No significant correlations were found between hormone levels and blood pressure or heart rate. The plasma ACTH concentration was significantly lower before admission to hospital than immediately after the accident. Plasma cortisol, prolactin, and growth hormone concentrations were not significantly different between the two points of observation. In samples taken immediately after the accident (t1), there was a positive correlation between both beta endorphin and prolactin and the injury severity score, whereas cortisol levels were negatively correlated with injury severity score, suggesting impaired cortisol release from the adrenal cortex after severe injury. At t1 ACTH was correlated with cortisol and beta endorphin. Patients with head injuries had hormone concentrations similar to those without head injuries but with a similar injury severity score from injuries in other parts of the body. CONCLUSIONS: Lower cortisol concentrations in the very severely injured might be due to failure of the adrenal cortex to respond normally to ACTH stimulation. Growth hormone seems to play a major role in the response to trauma, reflecting an immediate stress response.

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Selected References

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  • EVANS EI, BUTTERFIELD WJH. The stress response in the severely burned: an interim report. Ann Surg. 1951 Oct;134(4):588–613. [PubMed]
  • King LR, McLaurin RL, Lewis HP, Knowles HC., Jr Plasma cortisol levels after head injury. Ann Surg. 1970 Dec;172(6):975–984. [PubMed]
  • MOORE FD. Endocrine changes after anesthesia, surgery, and unanesthetized trauma in man. Recent Prog Horm Res. 1957;13:511–582. [PubMed]
  • Harris MJ, Baker RT, McRoberts JW, Mohler JL. The adrenal response to trauma, operation and cosyntropin stimulation. Surg Gynecol Obstet. 1990 Jun;170(6):513–516. [PubMed]
  • Woolf PD, Cox C, Kelly M, Nichols D, McDonald JV, Hamill RW. The adrenocortical response to brain injury: correlation with the severity of neurologic dysfunction, effects of intoxication, and patient outcome. Alcohol Clin Exp Res. 1990 Dec;14(6):917–921. [PubMed]
  • Baker SP, O'Neill B, Haddon W, Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed]
  • Barton RN, Stoner HB, Watson SM. Relationships among plasma cortisol, adrenocorticotrophin, and severity of injury in recently injured patients. J Trauma. 1987 Apr;27(4):384–392. [PubMed]
  • Lindner KH, Strohmenger HU, Ensinger H, Hetzel WD, Ahnefeld FW, Georgieff M. Stress hormone response during and after cardiopulmonary resuscitation. Anesthesiology. 1992 Oct;77(4):662–668. [PubMed]
  • Brizio-Molteni L, Molteni A, Warpeha RL, Angelats J, Lewis N, Fors EM. Prolactin, corticotropin, and gonadotropin concentrations following thermal injury in adults. J Trauma. 1984 Jan;24(1):1–7. [PubMed]
  • Vaughan GM, Becker RA, Allen JP, Goodwin CW, Jr, Pruitt BA, Jr, Mason AD., Jr Cortisol and corticotrophin in burned patients. J Trauma. 1982 Apr;22(4):263–273. [PubMed]
  • Carey LC, Cloutier CT, Lowery BD. Growth hormone and adrenal cortical response to shock and trauma in the human. Ann Surg. 1971 Sep;174(3):451–460. [PubMed]
  • Meguid MM, Brennan MF, Aoki TT, Muller WA, Ball MR, Moore FD. Hormone-substrate interrelationships following trauma. Arch Surg. 1974 Dec;109(6):776–783. [PubMed]
  • Berson SA, Yalow RS. Radioimmunoassay of ACTH in plasma. J Clin Invest. 1968 Dec;47(12):2725–2751. [PMC free article] [PubMed]
  • Krieger DT, Allen W. Relationship of bioassayable and immunoassayable plasma ACTH and cortisol concentrations in normal subjects and in patients with Cushing's disease. J Clin Endocrinol Metab. 1975 Apr;40(4):675–687. [PubMed]
  • Tanaka K, Nicholson WE, Orth DN. Diurnal rhythm and disappearance half-time of endogenous plasma immunoreactive beta-MSH (LPH) and ACTH in man. J Clin Endocrinol Metab. 1978 Jun;46(6):883–890. [PubMed]
  • Carnes M, Goodman BM, Lent SJ, Vo H. High intensity venous sampling reveals subtle alterations in plasma adrenocorticotropin patterns in old rats. Endocrinology. 1993 Aug;133(2):608–616. [PubMed]
  • Daly JR, Fleisher MR, Chambers DJ, Bitensky L, Chayen J. Application of the cytochemical bioassay for corticotrophin to clinical and physiological studies in man. Clin Endocrinol (Oxf) 1974 Jul;3(3):335–345. [PubMed]
  • Wise L, Margraf HW, Ballinger WF. A new concept on the pre- and postoperative regulation of cortisol secretion. Surgery. 1972 Aug;72(2):290–299. [PubMed]
  • Lloyd DA, Teich S, Rowe MI. Serum endorphin levels in injured children. Surg Gynecol Obstet. 1991 Jun;172(6):449–452. [PubMed]
  • Zimmerman RS, Hayes RL, Morris DL, Lyeth BG, Dewey WL, Young HF. Beta-endorphin in cerebrospinal fluid and serum after severe head injury. Neurosurgery. 1990 May;26(5):764–770. [PubMed]
  • Lopez JA. Lack of correlation between beta-endorphin and severity of cranial trauma. Neurosurgery. 1991 Feb;28(2):335–335. [PubMed]
  • Guillemin R, Vargo T, Rossier J, Minick S, Ling N, Rivier C, Vale W, Bloom F. beta-Endorphin and adrenocorticotropin are selected concomitantly by the pituitary gland. Science. 1977 Sep 30;197(4311):1367–1369. [PubMed]
  • Nakao K, Nakai Y, Jingami H, Oki S, Fukata J, Imura H. Substantial rise of plasma beta-endorphin levels after insulin-induced hypoglycemia in human subjects. J Clin Endocrinol Metab. 1979 Dec;49(6):838–841. [PubMed]
  • Nakao K, Nakai Y, Oki S, Horii K, Imura H. Presence of immunoreactive beta-endorphin in normal human plasma: a concomitant release of beta-endorphin with adrenocorticotropin after metyrapone administration. J Clin Invest. 1978 Dec;62(6):1395–1398. [PMC free article] [PubMed]
  • Nakao K, Nakai Y, Oki S, Matsubara S, Konishi T, Nishitani H, Imura H. Immunoreactive beta-endorphin in human cerebrospinal fluid. J Clin Endocrinol Metab. 1980 Feb;50(2):230–233. [PubMed]
  • Chioléro R, Lemarchand T, Schutz Y, de Tribolet N, Felber JP, Freeman J, Jéquier E. Plasma pituitary hormone levels in severe trauma with or without head injury. J Trauma. 1988 Sep;28(9):1368–1374. [PubMed]
  • Gottardis M, Nigitsch C, Schmutzhard E, Neumann M, Putensen C, Hackl JM, Koller W. The secretion of human growth hormone stimulated by human growth hormone releasing factor following severe cranio-cerebral trauma. Intensive Care Med. 1990;16(3):163–166. [PubMed]
  • Reid RL, Hoff JD, Yen SS, Li CH. Effects of exogenous beta h-endorphin on pituitary hormone secretion and its disappearance rate in normal human subjects. J Clin Endocrinol Metab. 1981 Jun;52(6):1179–1184. [PubMed]
  • Hackl JM, Gottardis M, Wieser C, Rumpl E, Stadler C, Schwarz S, Monkayo R. Endocrine abnormalities in severe traumatic brain injury--a cue to prognosis in severe craniocerebral trauma? Intensive Care Med. 1991;17(1):25–29. [PubMed]
  • King LR, Knowles HC, Jr, McLaurin RL, Brielmaier J, Perisutti G, Piziak VK. Pituitary hormone response to head injury. Neurosurgery. 1981 Sep;9(3):229–235. [PubMed]
  • Matsuura H, Nakazawa S, Wakabayashi I. Thyrotropin-releasing hormone provocative release of prolactin and thyrotropin in acute head injury. Neurosurgery. 1985 Jun;16(6):791–795. [PubMed]

Articles from Journal of Accident & Emergency Medicine are provided here courtesy of BMJ Group