The endocrine response to severe burn trauma

Abstract

The endocrine system is frequently altered after a major burn trauma. Besides the endocrine response to stress characterized by hypercortisolism, several hypothalamus–hypophysis–target gland axes are rapidly perturbed within a few days. These alterations can persist in the long term and deserve an appropriate treatment. Disturbances in water clearance and glucidic metabolism are also common and need to be diagnosed and corrected to decrease morbidity in such patients. Bone and mineral metabolism is deeply compromised and requires correction of mineral abnormalities in order to improve symptoms and prevent bone loss. No large prospective and/or intervention trials are available to date to elaborate age-related, evidence-based recommendations to monitor and treat burn-related endocrine alterations.

Keywords::

• hypercortisolism
• hypocalcemia
• hypogonadism
• hypoparathyroidism
• hypophosphatemia
• inflammation
• osteoporosis
• SIADH

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The criticality of burn injuries often leads to a misdiagnosis of endocrine perturbation, which indeed is typical and rapidly developing after a major burn trauma.

• All endocrine axes are altered. Although some are metabolic responses to the burn-induced stress disorder (i.e., hypercortisolism) and represent markers of the pathophysiologic adaptations taking place after a burn trauma, others (i.e., thyroid disturbances) cannot be explained solely by the hypermetabolic response.

• Bone and mineral metabolism is deeply compromised and deserves correction of mineral ions (calcium, magnesium, phosphate) in order to prevent bone loss and other disturbances. Many of these abnormalities are a consequence of hypoparathyroidism, which often occurs after a major burn trauma.

• Although there is no need to correct hypercortisolism, other endocrine disturbances (e.g., syndrome of inappropriate ADH secretion, hyperglycemia) must be excluded/recognized and appropriately treated and monitored during the resuscitation procedures.

• Growth hormone replacement, β-blockers, bisphosphonates, testosterone or testosterone analogs have been shown to yield benefits and accelerate recovery after a burn trauma, such as improve wound healing and reduce muscle catabolism. Nonetheless, large randomized controlled trials are still needed in order to obtain evidence-based recommendations on the use of growth hormone replacement and/or β-blockers and/or bisphosphonates after a burn trauma.