Relationships among plasma cortisol, adrenocorticotrophin, and severity of injury in recently injured patients
Abstract
When samples were taken within 2 hr of accidental injury, plasma cortisol levels increased with injury severity score (ISS) in patients with minor and moderate injuries (ISS, 1-12) but decreased at higher ISS. Radioimmunoassay of adrenocorticotrophin (ACTH) showed very variable plasma concentrations at all ISS ranges. Like cortisol, ACTH increased with ISS up to a score of about 13, but it thereafter plateaued, and in patients with severe injuries plasma cortisol fell in relation to ACTH as well as in absolute terms. This suggested that although ACTH secretion was generally far from maximal the relatively low cortisol concentrations in the most severely injured were at least partly due to a poor response of the adrenal cortex to ACTH. In patients who presented late (more than 2 hr after injury) plasma cortisol levels were more variable and more strongly related to ACTH than at shorter times after injury. The variability of cortisol also increased with age. Patients with severe head injuries had cortisol and ACTH concentrations similar to those without head injuries but with a similar ISS from injuries in other parts of the body.
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Other pediatric TBI studies found an incidence of TSH deficiency at one year after injury (5%-12%) similar to adult TBI studies (2%-22%).
“Other pediatric TBI studies found an incidence of TSH deficiency at one year after injury (5%–12%) similar to that observed in adult TBI studies (2%–22%) [21,28,29,30].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [30]
During the acute phase after TBI, serum cortisol levels typically rise in response to stress and neuroinflammation, later declining towards baseline as the injury stabilizes.
“During the acute phase, serum cortisol levels typically rise in response to stress and neuroinflammation, later declining towards baseline as the injury stabilizes [7,48,49].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [49]
Additional studies using insulin or glucagon stimulation tests confirmed normalization of the adrenal axis in the majority of children over time.
“Additional studies using insulin or glucagon stimulation tests confirmed normalization of the adrenal axis in the majority of children over time [43,48,49].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [49]
Several studies have reported an association between early cortisol levels and injury severity, particularly in mild to moderate TBI, where normalization of cortisol levels has been linked with more favorable outcomes.
“Several studies have reported an association between early cortisol levels and injury severity, particularly in mild to moderate TBI, where normalization of cortisol levels has been linked with more favorable outcomes [48,49].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [49]
Admission cortisol levels within a few hours of injury in a person with an intact hypothalamic-pituitary axis tend to directly correlate with injury severity scores and neurologic outcomes.
“Admission cortisol levels within a few hours of injury in a person with an intact hypothalamic-pituitary axis tend to directly correlate with injury severity scores and neurologic outcomes.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [30]
Lower cortisol levels are seen in milder injury and the highest levels in the most severely injured.
“Lower cortisol levels are seen in milder injury and the highest levels in the most severely injured [30,31].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [30]
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Cited by 154
- Authors
- BARTON, R. N., STONER, H. B., & WATSON, S. M.
- Affiliations
- Salford Royal Hospital (GB)
- Venue
- The Journal of Trauma: Injury, Infection, and Critical Care
- Published
- 1987-04
- Volume
- 27
- Issue
- 4
- Pages
- 384-392
- ISSN
- 0022-5282 (ISSN-L)
- OpenAlex
- W2064421192
- Cited by
- 154
- References
- 0
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 5 · 2018: 2 · 2017: 1 · 2016: 7 · 2015: 5 · 2014: 3 · 2013: 5 · 2012: 6
- FWCI
- 1.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- plasma cortisol, ACTH, Injury Severity Score, trauma (physical injury), traumatic brain injury, age effects, severe injuries
- MeSH terms
- Adolescent, Adrenocorticotropic Hormone, Adult, Aged, Diagnosis-Related Groups, Female, Craniocerebral Trauma, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Pituitary-Adrenal System, Radioimmunoassay, Severity of Illness Index, Time Factors, Wounds and Injuries
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