Changes Of Hapothalamo-pituitary-adrenocortical/thyrodial Axis In Patients With Acute Trauma

Backgroud： With the development of social and economic globalindustrialization,the related research has received the attention of the medicalprofession at home and abroad.There are much experimental and clinical dataindicates that injury stress can activate hypothalamus-hypophysis system and itsSpontaneous incretion,change the production of related hormones to make theadaptations.Presently,there is a controversy over the clinical meaning of somehormones,there’s much studys of judging the order of traumatic severity or theprediction of fracture,while the conclusions are not totally the same.The study isaimed to investigate the changes of hypothalamic-pituitary-adrenal axis andhypothalamic-pituitary-thyroid axis,to evaluate the change of Endocrine System inpatients with acute trauma.Objective：To measure the changes of serum corticosterone，adrenocorticotropichormone （ACTH）,and thyroid-stimulating hormone(TSH)、 free triiodothyronine(FT3)、free thyroxine(FT4) levels in patients in acute trauma, and the investigate thechanges of hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroidaxis,to evaluate the change of Endocrine System in patients with traumatic fracture.Methods:32patients were divided into two groups according to the ISS scores:mild injury group(19patients, ISS<16)and severe injury group(13patients, ISS16),levels were measured within24hours after injury.At the same time, choose thirtyhealthy people as Normal Group. Measured and statistic the changes of laboratorymarks including serum corticosterone、 ACTH and thyroid-stimulatinghormone(TSH)、free triiodothyronine (FT3)、free thyroxine(FT4).Result：①The serum corticosterone and ACTH levels in severe injury groupwere lower than those in mild injury group(P<0.01) and the same trend with those inNormal Group(P<0.05)；The serum corticosterone and ACTH levels in normal groupwere lower than those in mild injury group(P<0.05)②The serum level of FT3of the patients in mild and severe group were both lower than that in the controlgroup(P<0.01).Conclusion:The results of this study demonstrate that the disorder of HPT axisand HPA axis,exist in the patients with traumatic fracture.More acute trauma patientshave adrenal insufficiency, the measurement of serum corticosterone and ACTHlevels helps to judge the severity of trauma.There is low T3syndrome in the patientswith traumatic fracture,It is helpful to differential diagnosis to determinate the serumlevel of FT3.