Endocrine response after burn.

The use of radioimmunoassays has made new advances in post-burn endocrine studies possible. The mean fasting IRI plasma (pl.) levels were elevated for 7 weeks, sometimes reaching very high values. During OGTT, an impaired glucose tolerance and insulin resistance could be found. Pl. HGH levels were normal or slightly increased, and their hypoglycemia-caused rise in the first two postburn weeks was blocked. Renin and Angiotensin II pl. levels were high or very high in almost all burned patients. They were very sensitive indicators of burn stress. ACTH pl. levels were in some respects unpredictable: sometimes very high, sometimes only moderately elevated, or normal. There was mostly no correlation between them and the respective 17-OHCS. Serum FSH was uniformly low or very low, while LH was high (25%), normal (31%) or low (44%). Pl. testosterone levels were uniformly very low, except for the first 1-2 postburn days, even in minor burns, their levels returning to normal during convalescence. The response after chorionic gonadotropin was similar. This severe peripheric endocrine gland involvement (burn toxins? impaired circulation?) could be found to some extent when T4 (thyroxine) levels in serum were measured, especially during TSH tests. There was no correlation between TSH and T4 values. The pituitary response (LH, TSH, less FSH) to TRF and LHRH was normal in all patients tested. All the above can have far reaching endocrine and metabolic consequences (catabolism, fuel supply, endocrine priorities), with many new research and therapeutic possibilities.