Skip to main content Accessibility help
×
Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-28T09:43:10.028Z Has data issue: false hasContentIssue false

10 - Neuroendocrine responses to physical trauma

Published online by Cambridge University Press:  05 August 2016

Frank Berkenbosch
Affiliation:
Department of Pharmacology, Medical Faculty, Free University
Nancy J. Rothwell
Affiliation:
University of Manchester
Frank Berkenbosch
Affiliation:
Vrije Universiteit, Amsterdam
Get access

Summary

Major trauma can provoke a neuroendocrine response that is characterized by activation of the sympathetic-adrenomedullary system and by stimulation of neurohypophysial neurones in the hypothalamus, resulting in alterations in synthesis and secretion of various pituitary hormones and subsequent changes in secretion of adrenal, pancreatic and thyroid hormones. This complex response has been well described after a variety of physical injuries, including long-bone fractures, multiple injuries and burns. The neuroendocrine response to physical injury is accompanied by and possibly causally linked to a number of metabolic and immunological disturbances in patients. These include negative nitrogen balance as a consequence of increased protein breakdown, changes in thermoregulation, metabolic acidosis and immunosuppression as evidenced by the high mortality caused by sepsis in traumatized patients. The neuroendocrine response to physical injury is thought to be initiated by three main factors: emotionality caused by perception, fluid loss and tissue damage. The temporal integration of a sequence of neuroendocrine and metabolic reactions has led to a division of the response to injury into two phases, which have been named the ‘ebb’ and ‘flow’ phase (Cuthbertson, 1930; Frayn, 1986).

The ebb phase, which lasts up to 12-24 h after injury, represents a coordinated response by the brain, and is characterized by mobilization of energy stores together with apparent restraints on energy utilization. Early studies have reported that the ebb phase is characterized by a fall in metabolic heat production. However, subsequent studies, in particular in humans, have demonstrated that heat production is usually raised soon after injury, with a magnitude dependent on the type and severity of the insult (Little, 1988).

The flow phase or catabolic phase is characterized by a rise in metabolic rate, roughly coincident with an increase in urinary nitrogen secretion, which lasts up to 10 days after the injury. This phase of the response resembles a state that has been denoted the acute phase response, which is known to be largely regulated by cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor (TNF) (Dinarello, 1984; Kaplan et al, 1989; Heinrich et al, 1990).

The main emphasis of this chapter is to review the nature and cause of changes in hormone concentrations that occur after physical injuries. A brief description of the possible effects is added, to promote a more adequate understanding of the regulatory role of the neurohormonal response to injury.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×