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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 1(4),327-331;2008
Original Article
Hypoadrenalism Following Trauma: Is Sepsis Always Necessary?
Ian M. Paquette and Kenneth W. Burchard
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
Received September 23, 2008; accepted, October 2, 2008; available online October 8, 2008
Abstract: Purpose of the Study: Trauma patients can exhibit the systemic inflammatory response syndrome (SIRS) without evidence of
infection. SIRS from infection has been associated with hypoadrenalism. We hypothesized that hypoadrenalism can accompany SIRS
from trauma without infection. To investigate this further, we performed a retrospective study of trauma patients admitted to the ICU at
our rural academic level 1 trauma center from October 2003- June 2005, with measurement of blood cortisol in the first 7 days after
injury (N=33). We determined the incidence of hypoadrenalism based on serum cortisol levels and performed a univariate analysis to
delineate factors associated with hypoadrenalism. Significant Findings: Twelve of 33 (36.6 %) were diagnosed with hypoadrenalism on
mean ICU day 2.8. SIRS was documented in 92% of hypoadrenal patients vs. 52% of patients without hypoadrenalism (p=0.021). No
patient had evidence of invasive infection. Younger age and higher ISS were also associated with hypoadrenalism. There were no
gender differences identified, although most patients in the study were male. There was a trend toward higher etomidate use in the
hypoadrenal group, although this was not statistically significant. Conclusions: Trauma patients who demonstrate SIRS early in their
ICU course may exhibit hypoadrenalism without infection. Younger age also appears to be associated with this alteration. Further study
is needed to determine the true incidence of this condition, and to better delineate which trauma patients are most susceptible.
(IJCEM809004).
Key Words: Hypoadrenalism, trauma, sepsis, sirs, etomidate
Full Text PDF
Address all correspondence to: Ian M Paquette MD Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH
03756. Fax: 603-650-8030, E-mail: Ian.Paquette@Hitchcock.org
Original Article
Hypoadrenalism Following Trauma: Is Sepsis Always Necessary?
Ian M. Paquette and Kenneth W. Burchard
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH
Received September 23, 2008; accepted, October 2, 2008; available online October 8, 2008
Abstract: Purpose of the Study: Trauma patients can exhibit the systemic inflammatory response syndrome (SIRS) without evidence of
infection. SIRS from infection has been associated with hypoadrenalism. We hypothesized that hypoadrenalism can accompany SIRS
from trauma without infection. To investigate this further, we performed a retrospective study of trauma patients admitted to the ICU at
our rural academic level 1 trauma center from October 2003- June 2005, with measurement of blood cortisol in the first 7 days after
injury (N=33). We determined the incidence of hypoadrenalism based on serum cortisol levels and performed a univariate analysis to
delineate factors associated with hypoadrenalism. Significant Findings: Twelve of 33 (36.6 %) were diagnosed with hypoadrenalism on
mean ICU day 2.8. SIRS was documented in 92% of hypoadrenal patients vs. 52% of patients without hypoadrenalism (p=0.021). No
patient had evidence of invasive infection. Younger age and higher ISS were also associated with hypoadrenalism. There were no
gender differences identified, although most patients in the study were male. There was a trend toward higher etomidate use in the
hypoadrenal group, although this was not statistically significant. Conclusions: Trauma patients who demonstrate SIRS early in their
ICU course may exhibit hypoadrenalism without infection. Younger age also appears to be associated with this alteration. Further study
is needed to determine the true incidence of this condition, and to better delineate which trauma patients are most susceptible.
(IJCEM809004).
Key Words: Hypoadrenalism, trauma, sepsis, sirs, etomidate
Full Text PDF
Address all correspondence to: Ian M Paquette MD Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH
03756. Fax: 603-650-8030, E-mail: Ian.Paquette@Hitchcock.org
