title: Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs.
abstract: BACKGROUND
  The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal response after trauma.
  
  
  METHODS
  Prospective, observational study of 50 trauma patients admitted to a level-1-trauma centre. Serum and saliva cortisol were followed from the accident site up to five days after trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied.
  
  
  RESULTS
  There was a significant decrease over time in serum cortisol both during the initial 24 h, and from the 2nd to the 5th morning after trauma. A significant decrease over time was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association was found between an injury severity score ≥ 16 (severe injury) and a low (< 200 nmol/L) serum cortisol at any time during the study period. The odds for a serum cortisol < 200 nmol/L was eight times higher in patients with continuous infusion of sedative/analgesic drugs compared to patients with no continuous infusion of sedative/analgesic drugs.
  
  
  CONCLUSIONS
  Total serum cortisol, calculated free cortisol, DHEA and DHEAS decreased significantly over time after trauma. Continuous infusion of sedative/analgesic drugs was independently associated with serum cortisol < 200 nmol/L.
authors: Department of Anaesthesia and Intensive Care, Institution of Surgery and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden. Electronic address: camilla.brorsson@anestesi.umu.se.
authors: Camilla
authors: C
authors: Brorsson
authors: Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden.
authors: Per
authors: P
authors: Dahlqvist
authors: Department of Mathematics and Mathematical Statistics, Umeå University, 901 87 Umeå, Sweden.
authors: Leif
authors: L
authors: Nilsson
authors: Department of Anaesthesia and Intensive Care, Institution of Surgery and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden.
authors: Johan
authors: J
authors: Thunberg
authors: Department of Surgery, Institution of Surgery and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden.
authors: Anders
authors: A
authors: Sylvan
authors: Department of Anaesthesia and Intensive Care, Institution of Surgery and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden.
authors: Silvana
authors: S
authors: Naredi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D003687:Dehydroepiandrosterone / Q000378:metabolism*; D019314:Dehydroepiandrosterone Sulfate / Q000378:metabolism*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010912:Pituitary-Adrenal Function Tests / Q000379:methods*; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000378:metabolism* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013548:Sweden; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology
chemical_list: D000305:Adrenal Cortex Hormones; D000700:Analgesics; D006993:Hypnotics and Sedatives; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone
keywords: Adrenal insufficiency; Multiple trauma; Sedatives