Adrenal Cortical Function in Severe Burns

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.