The Endocrine Response After Burns: Its Possible Correlations with the Immunology of Burns

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All major burns are followed by an at times exaggerated endocrine (and metabolic) response. Increased levels of ACTH, ADH, cortisol, aldosterone, catecholamines, glucagon, immunoreactive insulin, 17β-estradiol (in males), calcitonin, parathyroid hormone, renin, angiotensin II, 17- ketosteroids, 17-ketogenic steroids, 17-hydroxycorticosteroids, prolactin, reverse triiodothyronine (rT3), sometimes LH, and GH were found, together with low levels of T3, thyroxine (T4), testosterone (in males), FSH, dehydroepiandrosterone sulfate, and progesterone. The GH response after insulin administration caused hypoglycemia (due to low levels) during the first postburn weeks. TSH levels were usually normal. LHRH (GnRH) + TRH tests also were usually normal, with a low response during the third postburn week and impaired feedback mechanisms. Testosterone response in males (after human chorionic gonadotropin) is decreased after burns; TSH tests are almost normal.All of the above changes are closely connected with the immune response. Activities of monocytes, macrophages, B and T lymphocytes, the complement system, and phagocytosis are probably significantly influenced by the postburn endocrine response. The normal immune response needs energy and unimpaired proteosynthesis. Such changes as an exaggerated catabolism, lack of utilizable energy, and flooding with new antigens are common denominators for the deficient postburn immune response. Hormonal treatment and blocking of the exaggerated response of the burned organism could become an important new therapeutic method.

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