Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm

Mangieri, Paola; Suzuki, Kunio; Ferreira, Moema; Domingues, Lucilia; Casulari, Luíz Augusto

doi:10.1590/s0004-282x2003000100003

Cited by 37 publications

(21 citation statements)

References 29 publications

(39 reference statements)

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“…The second category of NTIS is associated to the decrease of the total T4 levels, as in the case of the two patient with SH described in the previous paper 1 . The decrease of the T4 levels in NTIS are probably due to a decreased T4 production (decreased hypothalamic TRH secretion) and to an increase of its metabolic clearance 5,10,11 .…”

Section: Discussionmentioning

confidence: 80%

“…TSH serum levels are almost always normal in NTIS, but they have been repor-ted to be low or high in some clinical settings [25][26][27] . In our previous study, we have observed that TSH was increased in five patients 1 . It is not totally clear why TSH level might be low or normal in the presence of low circulating T3.…”

Section: Discussionmentioning

confidence: 81%

“…In a previous paper 1 , we observed that patients with SH have a tendency to show lower T3 sed of 25 patients with benign diseases of the spine (BDS) (lumbar disc hernia or stable spinal trauma): eight females and 17 males, aged 41.3±14.2 years on average. The difference between the age of SH and of BDS patients was not statistically significant.…”

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 89%

“…In relation to the thyroid hormones we observed a decrease of the triodiodothyronine (T3) levels in a large part of the patients, but in the presence of normal levels of total thyroxine (T4) and thyroid-stimulating hormone (TSH) in most of the cases 1 . This hormonal profile could be explained by the intense stress to which the patients are submitted during the first 24 hours following SH 1 . However, the thyroidal hormonal profile of SH patients suggests that they might have developed a Nonthyroidal Illness Syndrome (NTIS), a currently preferred designation because it does not involve the definition of the metabolic state of the patient 2 .…”

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confidence: 89%

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Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

Casulari

Mangieri

Naves³

et al. 2004

Arq. Neuro-Psiquiatr.

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-We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH) is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS). In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A) 30 patients with SH (21 females and 9 males; 41.7±11.4 years) and B) a control group including 25 patients with benign diseases of the spine (BDS) (lumbar disc hernia or stable spinal trauma) (8 females and 17 males; 41.3±14.2 years). In a subgroup of eight patients of each group serum triiodothyronine (T3) and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p<0.05): T3 (ng/mL): SH = 58.7±1.1 and BDS = 74.5±13.9; free T4 (ng/dL): SH = 0.9±0.2 and BDS = 1.1±0.3. There was no significant difference in the serum levels of total thyroxine (T4) and thyroid-stimulating hormone (TSH) between the two groups: T4 (µg/dL): SH = 6.9±1.1 and BDS = 7.4±2.1; TSH (µUI/mL): SH = 1.5±0.8 and BDS = 1.8±1,0. In the sample of eight patients of each group we had the following results: T3 (ng/mL): SH = 66.8±3.8 and BDS = 77.2±1.1 (p <0.05); reverse T3 (ng/dL): SH = 32.8±8 and BDS = 24.7±2.2 (NS); T3/ reverse T3 ratio: SH = 2.6±0.3 and BDS = 3.3±0.4 (NS). Thyreoglobulin and microsomal antibodies were not detectable, except in one patient in the SH group. In conclusion, the SH patients present serum levels of T3 and free T4 significantly lower than that of BDS patients; the thyroidal hormone profile suggests that SH patients have developed the nonthyroidal illness syndrome.KEY WORDS: cerebral aneurysm, euthyroid sick syndrome, nonthyroidal illness syndrome, subarachnoid hemorrhage, thyroid hormones. Sindrome da doença não tiroideana em pacientes com hemorragia subaracnoidea devida a aneurisma cerebralRESUMO -Nós apresentamos previamente que a hemorragia subaracnoidea devido à ruptura de aneurisma intracraniano (SH) está associada com alterações no perfil hormonal nas primeiras 24 horas após o evento. Nós propusemos que as alterações hormonais observadas são devidas ao intenso estresse ao qual os pacientes estão expostos. Contudo, o perfil hormonal tireoidiano é indicativo da presença da síndrome da doença não tireoidiana (NTIS). Neste trabalho, examinamos se as alterações no perfil dos hormônios tireoidianos são compatíveis com a NTIS. Dois grupos de pacientes foram incluídos no estudo: A) 30 pacientes com SH (21 mulheres e 9 homens; 41,7±11,4 anos) e B) um grupo controle incluindo 25 pacientes com doenças benignas da coluna (BDS) (hérnia de disco lombar ou estável trauma da coluna) (8 mulheres e 17 homens; 41,3±14...

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 90%

mentioning

confidence: 89%

mentioning

confidence: 89%

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Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

Casulari

Mangieri

Naves³

et al. 2004

Arq. Neuro-Psiquiatr.

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Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury

Dimopoulou¹,

Tsagarakis²

Applied Physiology in Intensive Care Medicine

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Critical Care 2003, 7(Suppl 2):P001 (DOI 10.1186/cc1890) Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogo-nadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypo-pituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. To investigate cortisol reserve in head trauma, 35 consecutive patients (30 men) with a mean age of 36 ± 16 years were studied 5-60 days after physical injury. Patients were enrolled in the study within a few days before ICU discharge. First, a morning blood sample was obtained to measure baseline cortisol, and ACTH plasma levels. Subsequently, 1 µg synthetic ACTH was injected intravenously and, 30 min later, a second blood sample was drawn to determine stimulated plasma cortisol. Patients having stimulated cortisol levels below 18 µg/dl were defined as nonresponders to the low-dose stimulation test (LDST). Mean (± SD) values for ACTH, baseline, and stimulated cortisol concentrations were 49 ± 27 pg/ml, 19.7 ± 5.5 µg/dl and 23.6 ± 6.7 µg/dl, respectively. Six of the 35 patients (17%) failed the LDST. Nonresponders were similar to responders with regard to age, gender, and severity of head injury. However, nonresponders more frequently required vasopressors (6/6 vs 14/29, P = 0.02) and for a longer time interva...

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Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury

Dimopoulou¹,

Tsagarakis²

2009

Applied Physiology in Intensive Care Medicine

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Evaluation of pituitary and thyroid hormones in patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm

Cited by 37 publications

References 29 publications

Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury

Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury

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