Sugar or salt? The relative roles of the glucocorticoid and mineralocorticoid axes in traumatic shock
| Autor: | Richard L. Thomas, Matthew J. Martin, George E. Black, Matthew J. Eckert, Zachary S. Hoffer, Daniel W. Nelson |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Swine medicine.drug_class Resuscitation Shock Hemorrhagic Critical Care and Intensive Care Medicine Mineralocorticoids Internal medicine polycyclic compounds medicine Adrenal insufficiency Animals Shock Traumatic Glucocorticoids urogenital system business.industry Hemodynamics medicine.disease Traumatic Shock Endocrinology Mineralocorticoid Reperfusion Injury Shock (circulatory) Surgery medicine.symptom business hormones hormone substitutes and hormone antagonists Glucocorticoid Mineralocorticoid deficiency Adrenal Insufficiency medicine.drug |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 79:1023-1029 |
| ISSN: | 2163-0755 |
| Popis: | Glucocorticoid deficiency (GD) has been proposed as a key contributor to shock states, but the presence and role of acute mineralocorticoid deficiency may be of equal or greater significance. We sought to analyze the incidence and degree of acute mineralocorticoid deficiency and GD in an animal model of severe hemorrhage and shock.Fifty-seven swine underwent 35% volume-controlled hemorrhage followed by aortic cross-clamping for 50 minutes to induce truncal ischemia-reperfusion. Protocol-guided resuscitation was performed. Laboratory analysis included cortisol, aldosterone, and plasma renin activity. The aldosterone-to-renin ratio (ARR) was calculated at each time point, and changes were correlated to markers of perfusion.Mean baseline cortisol levels were 5.8 μg/dL. Following hemorrhage, there was a significant increase in mean cortisol to 9.2 μg/dL (p0.001). After 1 hour of reperfusion, there was no change in mean cortisol levels (9.8 μg/dL, p = 0.12). Mean baseline aldosterone was 13.3 pg/mL. Aldosterone levels before cross-clamp removal increased significantly to 115.1 pg/mL (p0.001) and then rapidly declined to 49.2 pg/mL (p0.001) after 1 hour of reperfusion. Conversely, baseline plasma renin activity was 0.75 ng/mL per hour and increased significantly before cross-clamp removal (1.8) and at 1 hour (8.9, both p0.001). The ARR at baseline was 96.1 and increased to 113.5 (p = 0.68) before cross-clamp removal but significantly declined following 1 hour of reperfusion to 7.6 (p0.001). Overall, this represented a 93% reduction in mean ARR following reperfusion. The degree of aldosterone deficiency correlated with degree of systemic shock as measured by arterial base deficit (r = 0.47, p = 0.04), while cortisol showed no correlation.Hemorrhagic shock with ischemia-reperfusion injury resulted in only modest impact on the glucocorticoid axis, but major dysfunction of the mineralocorticoid axis and severe hyperreninemic hypoaldosteronism. The degree of aldosterone deficiency may provide prognostic information or offer potential targets for pharmacologic intervention.Diagnostic study, level III. |
| Databáze: | OpenAIRE |
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