The evaluation of the adrenal and thyroid axes and glucose metabolism after burn injury in children.
BACKGROUND
Burn injury is an important trauma and can cause many hormonal and metabolic changes in the human body. In contrast to the situation with adults, there are inadequate number of studies on children with this condition. Our aim in this study was to determine the changes in the adrenal, thyroid axes and glucose metabolism in the acute and subacute period and relation to the percent total body surface area (TBSA) burned in children with major burn injury.


METHODS
A total of 90 hospitalized children aged 0-13 years (mean: 3.44 +/- 2.90 years) with major fluid burn injury were included in this study. Serum ACTH, cortisol, fasting glucose and insulin and thyroid hormones (free T3 and T4, TSH) were evaluated in the first 24 hours after the burn injury and on day 3 and month 3 consequently in all of the cases. An ACTH stimulation test was performed when necessary. Continuous variables were compared with analysis of variance and categorical variables were compared with the chi-square test. The Pearson correlation was used to determine the relation between ACTH and cortisol and between blood glucose and insulin (on day 1 and 3 and month 3). Also the correlation with the TBSA burned and the hormonal values were evaluated. A p value <0.05 was considered statistically significant.


RESULTS
ACTH and Cortisol level increased in first 24 hours and decreased significantly by time. The change of ACTH and Cortisol level with time was significantly related to the TBSA burned. ACTH and cortisol levels were found significantly correlated in each time-point, but the correlation was highest in 3rd month. The glucose level in the first 24 hours was significantly higher than day 3 and month 3 levels in all of the children. There was again a significant increase in the serum insulin level in the first 24 hours. However there was no difference between day 1 and 3 serum insulin levels. A correlation was found between serum glucose and insulin on the first day but not on day 3 or month 3. Free T3 and T4 levels increased by time. Pairwise comparisons indicated that 1st day free T3 and T4 level was significantly lower than both 3rd day and 3rd month levels.


CONCLUSIONS
ACTH, Cortisol and fasting blood glucose level increased significantly however serum insulin level was slightly higher in first 24 hours after burns in children. Thyroid hormones were found to be decreased acute period following burns but staying in normal levels.
Senel
Emrah
E
Department of Pediatric Surgery, Diskapi Children's Hospital, Ankara, Turkey. dremrah2000@yahoo.com
Kizilgun
Murat
M
Akbiyik
Fatih
F
Atayurt
Halil
H
Tiryaki
H Tugrul
HT
Aycan
Zehra
Z
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D002056:Burns / Q000097:blood* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005508:Food Deprivation; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007223:Infant; D007328:Insulin / Q000097:blood; D008297:Male; D010913:Pituitary-Adrenal System / Q000378:metabolism* / Q000503:physiopathology; D011446:Prospective Studies; D013961:Thyroid Gland / Q000378:metabolism* / Q000503:physiopathology; D013963:Thyroid Hormones / Q000097:blood; D013997:Time Factors
D007328:Insulin; D013963:Thyroid Hormones; D000324:Adrenocorticotropic Hormone; D005947:Glucose; D006854:Hydrocortisone