The adrenal response after severe XXXX .

@entity1 @entity1887 @entity2339 @entity701 @entity130
BACKGROUND: The integrity of the @entity2339 is a major determinant of the host response to stress. Relative @entity1887 has been implicated in poor outcome from systemic inflammatory states; however, whether low endogenous glucocorticoid levels are adaptive or pathologic remains controversial. The purpose of this study was to prospectively evaluate the @entity701 response and determine the incidence of occult @entity1887 after severe @entity130 . METHODS: Over an 18-month period, 22 severely injured @entity1 admitted to the surgical intensive care unit of our level 1 @entity130 center were prospectively identified and followed. Demographic and outcome data were tabulated. In addition, random serum @entity701 levels were obtained on days 0, 5, and 10 after injury. Relative @entity1887 was defined as a random serum @entity701 level less than 18 microg/dL. RESULTS: Mean baseline @entity701 levels were elevated (35 +/- 3 microg/dL) and significantly declined over the next 10 days (day 5: 24 +/- 2 microg/dL; and day 10: 22 +/- 2 microg/dL; P <0.01). Thirteen of 22 (60%) @entity1 had random serum @entity701 levels less than 18 microg/dL. Only 1 of the 2 @entity1 who died had a serum @entity701 level less than 18 microg/dL. The mean @entity701 levels at baseline were higher in the 2 @entity1 who died compared with those who survived but this was not statistically significant (43.4 +/- 8.8 microg/dL versus 35.0 +/- 3.6 microg/dL, P = 0.5). CONCLUSIONS: Serum @entity701 levels increased immediately and gradually returned towards normal after severe @entity130 . Occult @entity1887 was common (60%) in this small group of severely injured @entity1 . This did not, however, affect mortality in these @entity1 . Further study is needed to delineate the role of occult @entity1887 after severe injury.
