Document Detail


Pathophysiology of hypopituitarism in the setting of brain injury.
MedLine Citation:
PMID:  18481181     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The complex pathophysiology of traumatic brain injury (TBI) involves not only the primary mechanical event but also secondary insults such as hypotension, hypoxia, raised intracranial pressure and changes in cerebral blood flow and metabolism. It is increasingly evident that these initial insults as well as transient events and treatments during the early injury phase can impact hypothalamic-pituitary function both acutely and chronically after injury. In turn, untreated pituitary hormonal dysfunction itself can further hinder recovery from brain injury. Secondary adrenal insufficiency, although typically reversible, occurs in up to 50% of intubated TBI victims and is associated with lower systemic blood pressure. Chronic anterior hypopituitarism, although reversible in some patients, persists in 25-40% of moderate and severe TBI survivors and likely contributes to long-term neurobehavioral and quality of life impairment. While the rates and risk factors of acute and chronic pituitary dysfunction have been documented for moderate and severe TBI victims in numerous recent studies, the pathophysiology remains ill-defined. Herein we discuss the hypotheses and available data concerning hypothalamic-pituitary vulnerability in the setting of head injury. Four possible pathophysiological mechanisms are considered: (1) the primary brain injury event, (2) secondary brain insults, (3) the stress of critical illness and (4) medication effects. Although each of these factors appears to be important in determining which hormonal axes are affected, the severity of dysfunction, their time course and possible reversibility, this process remains incompletely understood.
Authors:
Joshua R Dusick; Christina Wang; Pejman Cohan; Ronald Swerdloff; Daniel F Kelly
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Pituitary     Volume:  15     ISSN:  1573-7403     ISO Abbreviation:  Pituitary     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-07     Completed Date:  2012-07-16     Revised Date:  2012-12-03    
Medline Journal Info:
Nlm Unique ID:  9814578     Medline TA:  Pituitary     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2-9     Citation Subset:  IM    
Affiliation:
Division of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Brain Injuries / complications*,  physiopathology*
Humans
Hypopituitarism / etiology*,  physiopathology*
Grant Support
ID/Acronym/Agency:
UL1 TR000124/TR/NCATS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  An efficient technique for the numerical solution of the bidomain equations.
Next Document:  Do neighborhood economic characteristics, racial composition, and residential stability predict perc...