Impact of Hemorrhagic Shock on Pituitary Function

Bellal Joseph, Ansab A. Haider, Viraj Pandit, Narong Kulvatunyou, Tahereh Orouji, Mohammad Khreiss, Andrew Tang, Terence OKeeffe, Randall Friese, Peter Rhee

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. Study Design Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. Results A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. Conclusions Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.

Original languageEnglish (US)
Pages (from-to)502-508
Number of pages7
JournalJournal of the American College of Surgeons
Volume221
Issue number2
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

Fingerprint

Hemorrhagic Shock
Pituitary Hormones
Hydrocortisone
Adrenocorticotropic Hormone
Blood Pressure
Hypopituitarism
Thyrotropin
Luteinizing Hormone
Wounds and Injuries
Hormones
Traumatic Shock
Erythrocyte Transfusion
Injury Severity Score
Trauma Centers
Patient Admission
Serum
Vasopressins
Hospital Emergency Service
Shock
Length of Stay

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Joseph, B., Haider, A. A., Pandit, V., Kulvatunyou, N., Orouji, T., Khreiss, M., ... Rhee, P. (2015). Impact of Hemorrhagic Shock on Pituitary Function. Journal of the American College of Surgeons, 221(2), 502-508. https://doi.org/10.1016/j.jamcollsurg.2015.02.026

Impact of Hemorrhagic Shock on Pituitary Function. / Joseph, Bellal; Haider, Ansab A.; Pandit, Viraj; Kulvatunyou, Narong; Orouji, Tahereh; Khreiss, Mohammad; Tang, Andrew; OKeeffe, Terence; Friese, Randall; Rhee, Peter.

In: Journal of the American College of Surgeons, Vol. 221, No. 2, 01.08.2015, p. 502-508.

Research output: Contribution to journalArticle

Joseph, B, Haider, AA, Pandit, V, Kulvatunyou, N, Orouji, T, Khreiss, M, Tang, A, OKeeffe, T, Friese, R & Rhee, P 2015, 'Impact of Hemorrhagic Shock on Pituitary Function', Journal of the American College of Surgeons, vol. 221, no. 2, pp. 502-508. https://doi.org/10.1016/j.jamcollsurg.2015.02.026
Joseph B, Haider AA, Pandit V, Kulvatunyou N, Orouji T, Khreiss M et al. Impact of Hemorrhagic Shock on Pituitary Function. Journal of the American College of Surgeons. 2015 Aug 1;221(2):502-508. https://doi.org/10.1016/j.jamcollsurg.2015.02.026
Joseph, Bellal ; Haider, Ansab A. ; Pandit, Viraj ; Kulvatunyou, Narong ; Orouji, Tahereh ; Khreiss, Mohammad ; Tang, Andrew ; OKeeffe, Terence ; Friese, Randall ; Rhee, Peter. / Impact of Hemorrhagic Shock on Pituitary Function. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 2. pp. 502-508.
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abstract = "Background Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. Study Design Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. Results A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. Conclusions Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.",
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AU - Pandit, Viraj

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AU - Orouji, Tahereh

AU - Khreiss, Mohammad

AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Friese, Randall

AU - Rhee, Peter

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N2 - Background Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. Study Design Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. Results A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. Conclusions Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.

AB - Background Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. Study Design Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. Results A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. Conclusions Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.

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