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Leslie Wise, MD; Harry W. Margraf, ScD; Walter F. Ballinger, MD

AMA Arch Surg. 1972;105(2):213-220.

Abstract
Severely burned patients have prolonged high levels of free plasma cortisol and a decrease in plasma corticosteroid binding globulin. The four consistent changes in the urinary corticosteroid excretion pattern were as follows: (1) prolonged increase in cortisol excretion, which may reflect the sustained high free plasma levels; (2) temporary increase of the 17-ketosteroids, followed by return to normal levels; (3) similar rise and fall in the Porter-Silber chromogen levels; and (4) prolonged increased excretion of 17-ketogenic steroids. The sustained increase of 17-ketogenic steroids, as opposed to the rapid decrease of Porter-Silber chromogens, suggests that corticosteroids other than cortisol are secreted in larger than normal quantities, in response to the prolonged stress of severe burns. The increased amounts of alpha-ketolytic corticosteroids in the plasma of these patients would support this hypothesis.

Author Affiliations
St. Louis

From the Department of Surgery, Washington University School of Medicine, St. Louis.

Footnotes
Accepted for publication April 7, 1972.

Read before the 29th annual meeting of the Central Surgical Association, Chicago, March 3, 1972.

Reprint requests to 4960 Audubon Ave, c/o Department of Surgery, Washington University School of Medicine, St. Louis 63110 (Dr. Wise).

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