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The neuroendocrine response to multiple trauma

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Abstract

The neuroendocrine response to multiple trauma is a coordinated, complex, changing response which has as its objective maintenance of life by preserving oxygen delivery and the mobilization and utilization of the synthetic and energetic substrates required by the body.

The afferent system is composed of neural input from the various chemoceptors, nociceptors, and baroceptors which monitor normal bodily function, in addition to the effects of plasma factors directly on the brain (e.g., glucose and amino acids). The efferent system is composed of the autonomic nervous system and the output of the anterior and posterior pituitary and other hormones. The efferent response is shown by measurements of ACTH, arginine vasopressin, growth hormone, prolactin, norepinephrineepinephrine, and opiate peptides. This efferent output then modulates the response of the pancreatic islets with the observed changes in glucagon and insulin and of the adrenal glands with additional changes in the catechol-amines and cortisol. The renin-angiotensin-aldosterone system involving the kidney and adrenal gland is another responding system.

The preceding relationships are discussed in some detail. Restoration of normal neuroendocrine function is best achieved by prompt restoration of blood volume, relief of pain and anxiety, restoration of normal food intake, excision of damaged tissue, and prevention of subsequent organ failure (e.g., pulmonary).

Résumé

La réaction neuro-endocrinienne provoqué par le polytraumatismé est une réaction variable complexe et coordonnée qui a pour but de maintenir la vie en assurant l'oxygénation tissulaire aussi que la mobilisation et l'emploi des composants synthétiques et énergétiques nécessaires au corps humain.

Le complexe afferent est constitué par les récepteurs chimiques, physiques qui assurent les fonctions normales et les facteurs plasmatiques qui agissent directement sur le cerveau (glucose et acides amines). Le complexe efferent est formé par le système nerveux autonome et par les hormones en particulier hypophysaires antérieures et postérieures. Son action est mésurable par le dosage de l'ACTH, de la vasapressive de l'hormone de croissance, de la prolactine, de la norépinephrine-épinephrine et des peptides opiacès. Cette action se répercute sur les islots de Longerhans du pancreas dont témoignent les modifications du taux du glucagon et de l'insuline et sur les glandes surrénales dont témoignent les modifications des catecholamines et du cortisol. Le complexe angiotensive aldosterone, dépendant des reins et des surrénales participe à cette réaction.

Ces interactions sont étudiées en détail. La restauration de la fonction neuroendocrinienne normale est assurée au mieux par la restauration rapide du volume sanguin, sur la suppression de la douleur et de l'anxiété, par le retour à la normale de l'alimentation par l'exérèse des tissus altérés et par la prévention de la défaillance des différents systèmes organiques (en particular du poumon).

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Authors and Affiliations

  1. Section on Surgery, Division of Biology and Medicine, Brown University, USA

    Donald S. Gann M.D. & Michael P. Lilly M.D.

  2. Rhode Island Hospital, 593 Eddy Street, 02902, Providence, Rhode Island, USA

    Donald S. Gann M.D. & Michael P. Lilly M.D.

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Supported in part by NIH grants GM27946 and AM26831, and a gift from the Haffenreffer Family Fund.

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Gann, D.S., Lilly, M.P. The neuroendocrine response to multiple trauma. World J. Surg. 7, 101–118 (1983). https://doi.org/10.1007/BF01655918

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