STRESS HORMONES IN ACCIDENT PATIENTS STUDIED BEFORE ADMISSION TO HOSPITAL

Objective-To assess stress hormone response in traumatised patients st udied at the site of injury and on their way to hospital. Methods-The study was prospective. Blood samples were taken from 77 patients immed iately after the arrival of the emergency physician at the site of the accident (t(1)) and shortly before patients' admission to hospital (t (2)). Plasma concentrations of beta endorphin, cortisol, adrenocortico trophic hormone (ACTH), prolactin, and growth hormone were measured. R esults-Trauma in out-of-hospital patients resulted in remarkably incre ased concentration of growth hormone within minutes. ACTH, cortisol, a nd prolactin were only moderately increased. No significant correlatio ns were found between hormone levels and blood pressure or heart rate. The plasma ACTH concentration was significantly lower before admissio n to hospital than immediately after the accident. Plasma cortisol, pr olactin, and growth hormone concentrations were not significantly diff erent between the two points of observation. In samples taken immediat ely after the accident (t(1)), there was a positive correlation betwee n both beta endorphin and prolactin and the injury severity score, whe reas cortisol levels were negatively correlated with injury severity s core, suggesting impaired cortisol release from the adrenal cortex aft er severe injury. At t(1) ACTH was correlated with cortisol and beta e ndorphin. Patients with head injuries had hormone concentrations simil ar to those without head injuries but with a similar injury severity s core from injuries in other parts of the body. Conclusions-Lower corti sol concentrations in the very severely injured might be due to failur e of the adrenal cortex to respond normally to ACTH stimulation. Growt h hormone seems to play a major role in the response to trauma, reflec ting an immediate stress response.