Abstract
Objective
Trauma-induced steroid changes have been studied post-hospital admission, resulting in a lack of understanding of the speed and extent of the immediate endocrine response to injury. The Golden Hour Study was designed to capture the ultra-acute response to traumatic injury.
Design
An observational cohort study including adult male trauma patients
Methods
We recruited 31 adult male trauma patients (mean age 28 (range 19–59) years) with a mean injury severity score of 16 (IQR 10–21). The median time to first sample was 35 (range 14–56) minutes, with follow-up samples collected 4-12 and 48-72 hours post-injury. Serum steroids in patients and age- and sex-matched healthy controls (n=34) were analysed by tandem mass spectrometry.
Results
Within one hour of injury, we observed an increase in glucocorticoid and adrenal androgen biosynthesis. Cortisol and 11-hydroxyandrostendione increased rapidly while cortisone and 11-ketoandrostenedione decreased, reflective of increased cortisol and 11-oxygenated androgen precursor biosynthesis by 11β-hydroxylase and increased cortisol activation by 11β-hydroxysteroid dehydrogenase type 1. Active classic gonadal androgens testosterone and 5α-dihydrotestosterone decreased while the active 11-oxygenated androgen 11-ketotestosterone maintained pre-injury levels.
Conclusions
Changes in steroid biosynthesis and metabolism occur within minutes of traumatic injury. Studies that address whether ultra-early changes in steroid metabolism are associated with patient outcomes are now required.
Trauma-induced steroid changes have been studied post-hospital admission, resulting in a lack of understanding of the speed and extent of the immediate endocrine response to injury. The Golden Hour Study was designed to capture the ultra-acute response to traumatic injury.
Design
An observational cohort study including adult male trauma patients
Methods
We recruited 31 adult male trauma patients (mean age 28 (range 19–59) years) with a mean injury severity score of 16 (IQR 10–21). The median time to first sample was 35 (range 14–56) minutes, with follow-up samples collected 4-12 and 48-72 hours post-injury. Serum steroids in patients and age- and sex-matched healthy controls (n=34) were analysed by tandem mass spectrometry.
Results
Within one hour of injury, we observed an increase in glucocorticoid and adrenal androgen biosynthesis. Cortisol and 11-hydroxyandrostendione increased rapidly while cortisone and 11-ketoandrostenedione decreased, reflective of increased cortisol and 11-oxygenated androgen precursor biosynthesis by 11β-hydroxylase and increased cortisol activation by 11β-hydroxysteroid dehydrogenase type 1. Active classic gonadal androgens testosterone and 5α-dihydrotestosterone decreased while the active 11-oxygenated androgen 11-ketotestosterone maintained pre-injury levels.
Conclusions
Changes in steroid biosynthesis and metabolism occur within minutes of traumatic injury. Studies that address whether ultra-early changes in steroid metabolism are associated with patient outcomes are now required.
| Original language | English |
|---|---|
| Article number | lvad024 |
| Journal | European Journal of Endocrinology |
| Early online date | 21 Feb 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 21 Feb 2023 |