| Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation. | |
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MedLine Citation:
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PMID: 19459759 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Neuroendocrine dysfunction following traumatic brain injury (TBI) has been described extensively. However, few studies are longitudinal and most lack subtle radiological, clinical, and repetitive endocrine assessment in the acute phase. Accordingly, we prospectively assessed neuroendocrine function in 71 patients after TBI. Injury was documented by a computed tomography (CT). During the first week, critical clinical data (Glasgow Coma Score, APACHE score), treatment variables such as duration of analgosedation for mechanical ventilation, were related to basal pituitary function. More than 2 years later, a subgroup of patients was re-evaluated using dynamic testing with ACTH and GHRH-arginine tests. The Pearson's correlation analysis and Mann-Whitney rank sum test for group differences were used for statistical analysis. None of the CT findings predicted neuroendocrine dysfunction following TBI. The adaptive response to critical illness with significantly elevated cortisol levels on admission and decreased levels thereafter in patients ventilated for more than 24 h (p < 0.05) was attenuated following severe TBI (p < 0.05). However, the coincidence of low serum cortisol and increased urinary excretion of glucocorticoid metabolites in about 80% of patients challenges the relevance of basal hormone measurements. In ventilated patients, total T3 and free T4 were decreased (p < 0.05), TSH was low on day 3 (p < 0.05), and a gonadotropic insufficiency was present (p < 0.05). The thyrotropic and gonadotropic system recovered completely within the follow-up period. With regard to the somatotropic system, neither brain injury severity nor mechanical ventilation was associated with an insufficiency during the acute phase post-injury. However, initially low GH levels predicted a persistent deficiency (r = 0.731, p < 0.001). We conclude that both severe TBI and prolonged mechanical ventilation result in hormonal disturbances early after injury, suggesting a pathophysiological response to brain injury and subsequent intensive care treatment rather than morphological damage. |
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Authors:
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Andrea Kleindienst; Georg Brabant; Christoph Bock; Christiane Maser-Gluth; Michael Buchfelder |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of neurotrauma Volume: 26 ISSN: 1557-9042 ISO Abbreviation: J. Neurotrauma Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-09-01 Completed Date: 2009-12-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8811626 Medline TA: J Neurotrauma Country: United States |
Other Details:
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Languages: eng Pagination: 1435-46 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, University Erlangen-Nuremberg, Erlangen, Germany. andrea.kleindienst@uk-erlangen.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adrenal Cortex Hormones / blood Adult Aged Aged, 80 and over Brain Injuries / physiopathology*, radiography Female Follow-Up Studies Glasgow Coma Scale Hormones / blood Human Growth Hormone / blood Humans Intensive Care Longitudinal Studies Male Middle Aged Neurosecretory Systems / physiopathology* Prospective Studies Receptors, Somatotropin / metabolism Thyroid Hormones / blood Treatment Outcome Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Adrenal Cortex Hormones; 0/Hormones; 0/Receptors, Somatotropin; 0/Thyroid Hormones; 12629-01-5/Human Growth Hormone |
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