Search

Objective To determine free and total cortisol serum concentrations in the first 24 h after trauma and to evaluate the influence of traumatic brain injury (TBI) on their dynamics.Methods This prospective cohort study enrolled patients who had experienced multiple trauma and were admitted to a level 1 trauma centre. The patients were divided in two groups based on the presence of TBI according to clinical and radiological findings. Blood was collected initially as well as at 12 h and 24 h after the traumatic injury. Total cortisol, corticosteroid binding globulin (CBG) and free cortisol levels were determined.Results The study analysed data from 49 patients (36 males and 13 females) with a mean ± SD age of 45.0 ± 16.0 years. Of these, 36 presented with TBI and 13 had multiple injuries without TBI. Patients with TBI showed significantly lower concentrations of total cortisol and free cortisol compared with patients without TBI. Repeated measures analysis revealed different concentration dynamics in patients with TBI, with no increase in cortisol after trauma.Conclusion Multiple trauma patients with TBI are at risk of acute impaired cortisol secretion and show an attenuated stress response as early as 12 h after injury.

The somatotropic axis interacts with the central nervous system (CNS) on several levels. Growth hormone (GH) and insulin-like growth factor-I (IGF-I) receptors are expressed in many brain areas including the hippocampus, pituitary and hypothalamus. GH and IGF-I can pass the blood-brain barrier by an as yet not completely understood mechanism. They can also be produced in the brain and thus act via paracrine/autocrine mechanisms. GH and IGF-I are important factors in the development and differentiation of the CNS and have protective properties in dementia, and in traumatic and ischemic injury of the CNS. An improvement in cognitive functioning in GH-deficient patients by GH substitution has been shown. Significant results could, however, only be achieved with supraphysiological doses. In some studies, a correlation between IGF-I and cognitive function in the elderly has been found. GH has an important impact on mood and well-being with GH secretory capacity being reduced in depression. Pulsatile GH secretion is closely related to slow wave sleep (SWS) with SWS being stimulated by GH releasing hormone and rapid eye movement (REM) sleep by GH.

We describe and discuss an evolutionary tree derived from data which were obtained using monoclonal antibodies.