Metabolic modulators following trauma sepsis: sex hormones

Crit Care Med. 2007 Sep;35(9 Suppl):S621-9. doi: 10.1097/01.CCM.0000278603.18687.4F.


Background: The development of metabolic perturbations following severe trauma/sepsis leading to decreased energy production, hyperglycemia, and lipolysis is often rapid. Gender is increasingly recognized as a major factor in the outcome of patients suffering from trauma/sepsis. Moreover, sex hormones influence energy, glucose, and lipid metabolism. Metabolic modulators, such as peroxisome proliferator-activated receptor-gamma coactivator-1 and peroxisome proliferator-activated receptor-alpha, which are required for mitochondrial energy production and fatty acid oxidation, are regulated by the estrogen receptor-beta and consequently contribute to cardioprotection following trauma hemorrhage. Additionally, sex steroids regulate inflammatory cytokines that cause hypermetabolism/catabolism via acute phase response, leading to increased morbidity and mortality.

Measurements: This article examines the following: (1) the evidence for gender differences; (2) energy, glucose, and lipid metabolism and the acute phase protein response; (3) the mechanisms by which gender/sex hormones affect the metabolic modulators; and (4) the tissue-specific effect of sex hormone receptors and the effect of genomic and nongenomic pathways of sex hormones following trauma.

Results and conclusions: The available information indicates that sex steroids not only modulate the immune/cardiovascular responses but also influence various metabolic processes following trauma. Thus, alteration or modulation of the prevailing hormone milieu at the time of injury appears to be a novel therapeutic adjunct for improving outcome after injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute-Phase Proteins / metabolism
  • Adenosine Triphosphate / biosynthesis
  • Animals
  • Cytokines / metabolism
  • Energy Metabolism
  • Female
  • Glucose / metabolism
  • Gonadal Steroid Hormones / metabolism*
  • Humans
  • Lipid Metabolism
  • Male
  • Mitochondria / metabolism
  • PPAR alpha / metabolism
  • Sepsis / metabolism*
  • Sepsis / physiopathology
  • Sex Characteristics
  • Wounds and Injuries / metabolism*
  • Wounds and Injuries / physiopathology


  • Acute-Phase Proteins
  • Cytokines
  • Gonadal Steroid Hormones
  • PPAR alpha
  • Adenosine Triphosphate
  • Glucose