Posttraumatic stress reactions and HPA system regulation in patients with acute spinal cord injury: a repeated measures approach

Objective: Research results over the past years have provided evidence for acute and chronic alterations of the endocrinological stress system in posttraumatic stress disorder (PTSD). However, the underlying pathogenesis and the chronological sequence of alterations in hypothalamic-pituitary-adrenal (HPA) activity still remain unclear. Heterogenous sample protocols and differing assessment methods complicate the interpretation of the existing data. Most studies examining basal HPA activity were conducted on patients with chronic PTSD like war veterans. Hence, it is unclear at which point of the pathogenesis the alterations of the HPA axis occur. Longitudinal, prospective studies on homogenous samples of patients with acute traumatization are necessary in order to draw valid conclusions about the process of HPA axis alteration. Methods: Two months post-accident, patients (N=15) with an acute spinal cord injury were recruited in two regional trauma centers. Urinary cortisol and dehydroepiandrosterone (DHEA) were assessed weekly over a period of six weeks. To assess the psychological state and control for potentially confounding variables during the urine collection, an accompanying questionnaire was employed. Results: Preliminary data of the six-week endocrine assessment and its interaction with the psychopathological status will be presented at the conference.