Effect of Burn Trauma on Adrenal and Testicular Steroid Hormone Production*

Abstract

The effects of burn trauma in men on the production of adrenal and testicular steroids was investigated. Whereas there were significant increases in serum cortisol levels and urinary 17-hydroxycorticosteroid excretion soon after thermal injury, there were significant decreases in serum dehydroepiandrosterone sulfate, dehydroepiandrosterone, androstenedione, and testosterone concentrations during the first 4 weeks following burn trauma. Serum androstenediol and androstenediol sulfate levels also were reduced, though insignificantly, 10-23 days postburn. Serum LH levels were unchanged during the postburn interval. Since urinary 17-ketosteroid excretion was normal or below normal rather than increased, the decline in serum C19-steroid levels probably resulted from decreased glandular secretion rather than increased rates of metabolism and excretion. Low dehydroepiandrosterone sulfate and/or testosterone levels were found in some men several months after recovery from their burns. These data suggest that thermal injury leads to acute inhibition of adrenal and testicular C19-steroid secretion, but stimulation of adrenal glucocorticosteroid production, and that endocrine function in many instances is not normalized after complete healing of the burned surfaces. The mechanisms and physiological consequences of such changes in the steroid milieu of men after burn trauma are unknown.

Testosterone receptor blockade restores cellular immunity in male mice after burn injury

“…In fact, androgen depletion by castration or flutamide treatment has been shown to increase estrogen receptor expression in a variety of cells, including T cells (West et al 1990, Bodker et al 1994, Kruithof-Dekker et al 1996, Samy et al 2000. Furthermore, preliminary studies suggest that, not only are estrogen concentrations increased after burn as previously reported (Woolf et al 1985, Lephart et al 1987, but flutamide treatment further augments this increase (K A N Messingham, M A Emanuele and E J Kovacs, unpublished observation). Such flutamide-induced increases in estrogen receptor expression would have little function in vitro (in the absence of estrogen); however, increased estrogen receptor expression on lymphocytes, in combination with increased circulating estradiol after burn injury, would probably stimulate lymphocyte functions in vivo.…”

“…Specifically, estrogen concentrations are enhanced in both males and females, whereas testosterone is decreased in males (Woolf et al 1985, Lephart et al 1987, Christeff et al 1992, Fourrier et al 1994, Sharma et al 1996. Despite the finding that injury decreases the immune-suppressive androgenic hormones, flutamide treatment consistently results in restoration of cellular immune function after trauma (Wichmann et al 1996.…”

“…Whereas increased glucocorticoids after injury are believed to regulate the decrease in testosterone after injury (Lephart et al 1987), glucocorticoid concentrations are not affected by flutamide treatment . Thus the beneficial effects of flutamide treatment on immunity after injury are not the result of decreased circulating corticosterone.…”

“…Burn and other traumatic injuries have been shown to decrease circulating testosterone concentrations in males (Lephart et al 1987). To evaluate whether our burn injury altered testosterone concentrations, and if flutamide treatment had any effect on these values, circulating total testosterone was measured by RIA.…”

Sex differences and estrogen modulation of the cellular immune response after injury

“…Consistent with these observations, lower survival rates in female mice compared to males with 15% total body surface area (TBSA) were obtained [30]. Estrogen levels are significantly higher (10-15 fold over baseline) in females following burn injury [31], whereas concentrations of circulating testosterone are decreased [32,33]. These observations suggest that significantly higher levels of estrogen may lead to improper cell mediated immune response.…”