title: Impact of Hemorrhagic Shock on Pituitary Function.
abstract: BACKGROUND
  Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock.
  
  
  METHODS
  Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones.
  
  
  RESULTS
  A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived.
  
  
  CONCLUSIONS
  Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Orouji
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khreiss
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Randall
authors.initials: R
authors.lastname: Friese
authors.affiliation: Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000208:Acute Disease; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007018:Hypopituitarism / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000097:blood / Q000150:complications*; D013972:Thyrotropin / Q000097:blood; D014667:Vasopressins / Q000097:blood; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications*
chemical_list: D015415:Biomarkers; D014667:Vasopressins; D000324:Adrenocorticotropic Hormone; D007986:Luteinizing Hormone; D013972:Thyrotropin; D006854:Hydrocortisone