Cortisol in severely burned patients: investigations on disturbance of the hypothalamic-pituitary-adrenal axis.

Thermal injuries of more than 20% of body surface area lead to conditions resembling a severe systemic inflammatory response syndrome, such as in septic shock. It has been shown that septic shock may lead to disturbances in cortisol metabolism and balance of the hypothalamic-pituitary-adrenal axis. To investigate whether such a disturbance also occurs in the very early stages of systemic inflammatory response syndrome in burned patients, we performed 20 corticotropin-releasing hormone tests on day 1 after admission to our unit. In 7 of 20 patients, a disturbance of cortisol secretion could be demonstrated. Four patients developed adrenal insufficiency. The correlation between the abbreviated burn severity index and the risk of developing adrenal insufficiency was significant (P = 0.008). We observed a higher mortality rate in adrenally insufficient patients; however, because of the small patient number, we were not able to prove this observation with a statistical significant correlation (P = 0.11). Our findings indicate that temporary adrenal insufficiency occurs in the early stages of severe injury. Further investigations will have to be performed to clarify whether such patients benefit from cortisol replacement.