A. A. Haider1, P. Rhee1, V. Pandit1, N. Kulvatunyou1, B. Zangbar1, M. Mino1, A. Tang1, T. O’Keeffe1, R. Latifi1, R. S. Friese1, B. Joseph1 1University Of Arizona,Trauma/Surgery/Medicine,Tucson, AZ, USA
Introduction:
Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. Understanding the hormonal variations in trauma patients with hemorrhagic shock (HS) has been gaining focus. However; the effects of HS on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormonal variations in trauma patients with hemorrhagic shock (HS).
Methods:
Patients with acute traumatic HS presenting at our level 1 trauma center were prospectively enrolled. HS was defined as systolic blood pressure (SBP) ≤ 90 mm Hg 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 with mean age 36.7±12.4 years , mean SBP 88±64.5 mm of Hg, and median injury severity score 26 [18-38] . The mean admission ADH level was 20.4±9.6 pg/ml, mean admission ACTH level was 42±38.4pg/ml, and mean admission cortisol level was 19.4±7.4 µg/dl. The pattern of pituitary hormones was variable over the 5 days (Figure 1). Four patients died within 24 hrs. Patients who died had higher mean admission ADH levels (p=0.01), higher mean admission ACTH levels (p=0.02), and lower mean admission cortisol levels (p=0.01) compared to patients who survived. On sub-analysis of patients who died after 24hrs (n=6), there was a significant decrease in the level of ADH (p=0.041) and cortisol (p=0.036).
Conclusion:
Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. The physiological response of the pituitary adrenal axis in HS was appropriate. The pituitary hormone levels were variable over the 5 days. In patients who died there was a decreasing trend in the ADH and cortisol level.
