Avaliação tardia do eixo hipofisário-gonadal em pacientes adultos que sofreram traumatismo cranioencefálico grave

Hohl, Alexandre; Daltrozo, Jordana Bernardi; Pereira, Camila Girardi; Weber, T.; Pinto, Heyde Francine; Gullo, Jackson da Silva; Bernardini, Juçara Deitos; Coral, Marisa Helena César; Walz, Roger

doi:10.1590/s0004-27302009000800016

Cited by 10 publications

(6 citation statements)

References 28 publications

(27 reference statements)

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“…In the two largest series published [32,33], gonadotrophic was the second most affected among the pituitary axes and the prevalence of chronic post-TBI hypogonadism was 9%. A study by our group has shown similar results [34].…”

Section: Acute and Chronic Hypogonadism After Tbisupporting

confidence: 73%

Androgens, Male Hypogonadism and Traumatic Brain Injury

Hohl¹,

Ronsoni²,

Sande‐Lee³

et al. 2014

OJEMD

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Traumatic brain injury (TBI) is a worldwide public health problem. Populations with a growing number of vehicles are experiencing many traumas and accidents. The highest-risk group is young men. Significant advances in neurosurgery and intensive therapy have resulted in increased survival rates of TBI patients. These higher survival rates, in turn, have led to an increasingly higher number of patients with neurological, cognitive, clinical, and social problems. This lack of knowledge about TBI has been called by some "the silent epidemic". In recent years, studies of patients with moderate and severe TBI are increasing. Glasgow Coma Scale ≤ 8 and abnormal pupils at admission are used to determine the prognosis of patients with moderate or severe TBI. Several biomarkers such as interleukins, thiobarbituric acid reactive species, and some hormones have been studied in an effort to aid prognosis. Testosterone plays a key role in men. Thus, an understanding of androgens in TBI is essential to follow these survivors of head trauma. This review will discuss the epidemiology of TBI, its association with male hypogonadism, and possible treatments.

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Section: Acute and Chronic Hypogonadism After Tbisupporting

confidence: 73%

Androgens, Male Hypogonadism and Traumatic Brain Injury

Hohl¹,

Ronsoni²,

Sande‐Lee³

et al. 2014

OJEMD

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“…Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities (1–5). Depending on the TBI severity and its complications, even in the absence of motor impairment, the TBI may result in cognitive deficits (6, 7), endocrine (8) and psychiatric disorders (9–11) affecting work capacity (12), and impairing the quality of life (9).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

et al. 2019

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Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male ( n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% ( n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.

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“…Described in 1918 ( 8 ), partial or complete hypopituitarism is a potential consequence of TBI ( 9 , 10 ). There are several mechanisms by which TBI can cause hypothalamus-pituitary dysfunction, including hypoxic insult or direct mechanical injury to the hypothalamus, pituitary stalk or the gland itself, compression from hemorrhage, edema or increased intracranial pressure, and vascular injury to the hypothalamus or the pituitary gland ( 10 – 13 ).…”

Section: Chronic Hypopituitarism and Tbimentioning

confidence: 99%

“…We reviewed the 10 articles available in PubMed (see Table 1 ) that evaluated LH and testosterone levels in adult male patients during hospitalization for severe TBI ( 9 , 10 , 14 – 21 ). In nine studies ( 9 , 10 , 13 – 21 ), hormone levels were determined in the first 10 days after TBI. In one study ( 14 ), levels were measured up to 20 days after the injury.…”

Section: Lh As Biomarker Of Mortality In Severe Tbimentioning

confidence: 99%

Luteinizing Hormone and Testosterone Levels during Acute Phase of Severe Traumatic Brain Injury: Prognostic Implications for Adult Male Patients

et al. 2018

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Traumatic brain injury (TBI) is a worldwide core public health problem affecting mostly young male subjects. An alarming increase in incidence has turned TBI into a leading cause of morbidity and mortality in young adults as well as a tremendous resource burden on the health and welfare sector. Hormone dysfunction is highly prevalent during the acute phase of severe TBI. In particular, investigation of the luteinizing hormone (LH) and testosterone levels during the acute phase of severe TBI in male has identified a high incidence of low testosterone levels in male patients (36.5–100%) but the prognostic significance of which remains controversial. Two independent studies showed that normal or elevated levels of LH levels earlier during hospitalization are significantly associated with higher mortality/morbidity. The association between LH levels and prognosis was independent of other predictive variables such as neuroimaging, admission Glasgow coma scale, and pupillary reaction. The possible mechanisms underlying this association and further research directions in this field are discussed. Overall, current data suggest that LH levels during the acute phase of TBI might contribute to accurate prognostication and further prospective multicentric studies are required to develop more sophisticated predictive models incorporating biomarkers such as LH in the quest for accurate outcome prediction following TBI. Moreover, the potential therapeutic benefits of modulating LH during the acute phase of TBI warrant investigation.

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Avaliação tardia do eixo hipofisário-gonadal em pacientes adultos que sofreram traumatismo cranioencefálico grave

Cited by 10 publications

References 28 publications

Androgens, Male Hypogonadism and Traumatic Brain Injury

Androgens, Male Hypogonadism and Traumatic Brain Injury

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

Luteinizing Hormone and Testosterone Levels during Acute Phase of Severe Traumatic Brain Injury: Prognostic Implications for Adult Male Patients

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