Adrenal insufficiency in severely wounded men with combat gunshot injury

Abstract

War destroys normal life and is the main factor of human psychological and physical vulnerability. The stress of war is the most powerful pathogenic factor in the emergence, detection and exacerbation of somatic, mental and behavioral disorders. Trauma can affect the functioning of the hypothalamus and pituitary gland, as well as affect the hypothalamic-pituitary-adrenal axis. One of these strong physical types of stress is gunshot injury and, consequently, surgical intervention resulting in metabo­lic and physiological disturbances. During stress, an excessive amount of cortisol is produced, but when the human body is exhausted, the level of this hormone decreases, and then adrenal insufficiency occurs. The article considered secondary adrenal insufficiency that can develop as a result of surgical intervention after combat trauma with massive blood loss, which can be objectively characterized as acute stress in male combatants. It is important to pay attention to the recognition and early prevention of hypoglycemia in adrenal insufficiency. So, continuous glucose monitoring should be used. Although this test is quite safe, it is desirable to have a simpler diagnostic marker that can be obtained without the administration of adrenocorticotropic hormone. It is also recommended to study the level of cortisol in blood serum, pay attention to the deficiency of sex hormones. Measurement of dehydroepiandrosterone and dehydroepiandrosterone sulfate should be included in the laboratory assessment of hypothalamic-­pituitary-adrenal axis function. Dynamic measurements of dehydroepiandrosterone have proven to increase the accuracy of diagnosing adrenal insufficiency. Thus, adrenal insufficiency can cause non-specific symptoms in a person who has acute stress. Early detection and testing based on clinical suspicion can prevent further development of adrenal crisis.