Management of the trauma victim with pre-existing endocrine disease.

The clinical course of individuals after trauma largely is determined by their pretraumatic state. The endocrine system plays a major role in the response to injury, surgery, and sepsis, and endocrine dysfunction places the trauma victim at risk of greater morbidity and mortality. Further, chronic endocrine disease usually is accompanied by multiorgan dysfunction, which may compromise the physiologic reserve of the critically injured patient. Among patients with pre-existing endocrine disease, the severe stresses of multisystem trauma can lead to a further, often subtle, decompensation in endocrine function (Fig. 1). In the management of trauma victims with pre-existing endocrine disease, the role of the critical care specialist is three-fold--(1) to maintain a high index of suspicion for endocrine disease in all trauma victims, (2) to anticipate and prevent endocrine organ decompensation, and (3) to rapidly diagnose and institute therapy in those suspected of having endocrine disease.