Djordje Marina1, Marianne Klose1, Annette Nordenbo1, Annette Liebach1, Ulla Feldt-Rasmussen2. 1. Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark. 2. Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark ufeldt@rh.dk.
Abstract
OBJECTIVE: Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. DESIGN: Prospective study at a tertiary university referral centre. METHODS: A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. RESULTS: Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months. CONCLUSION: The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
OBJECTIVE: Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. DESIGN: Prospective study at a tertiary university referral centre. METHODS: A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. RESULTS: Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months. CONCLUSION: The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
Authors: Rastafa I Geddes; Kentaro Hayashi; Quinn Bongers; Marlyse Wehber; Icelle M Anderson; Alex D Jansen; Chase Nier; Emily Fares; Gabrielle Farquhar; Amita Kapoor; Toni E Ziegler; Sivan VadakkadathMeethal; Ian M Bird; Craig S Atwood Journal: PLoS One Date: 2017-01-26 Impact factor: 3.240
Authors: Rachel K Rowe; Benjamin M Rumney; Hazel G May; Paska Permana; P David Adelson; S Mitchell Harman; Jonathan Lifshitz; Theresa C Thomas Journal: Endocr Connect Date: 2016-06-17 Impact factor: 3.335
Authors: Rastafa I Geddes; Amita Kapoor; Kentaro Hayashi; Ryan Rauh; Marlyse Wehber; Quinn Bongers; Alex D Jansen; Icelle M Anderson; Gabrielle Farquhar; Sivan Vadakkadath-Meethal; Toni E Ziegler; Craig S Atwood Journal: Endocrinol Diabetes Metab Date: 2021-03-18