Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults

Krahulík, David; Zapletalová, Jiřina; Fryšák, Zdeněk; Vaverka, Miroslav

doi:10.3171/2009.10.jns09930

Cited by 90 publications

(62 citation statements)

References 20 publications

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“…Head injured patients in NIC should be monitored for nine key body systems: a) central nervous system (discussed specifically under brain monitoring); b) cardiovascular system which includes parameters such as heart rate and rhythm, blood and venous pressure, stroke volume, cardiac output and total peripheral resistance; c) pulmonary system with regular monitoring of arterial blood gases, chest radiographs, and breathing and ventilator parameters; d) renal and metabolic system with regular blood, urine and metabolic profiles monitoring; e) gastrointestinal and nutritional status pertaining to body calories; f) hematological profiles; g) microbiologic and sepsis profiles; h) peripheries and skin condition and lastly i) endocrine and hormonal profiles which are frequently overlooked, except for features of diabetes insipidus or syndrome of inappropriate antidiuretic hormone hypersecretion. Recent studies have demonstrated 75% incidence of endocrine dysfunction at 6 months post trauma in children and 21% incidence of hypothalamic-pituitary dysfunction in adults (Kaulfers et al, 2010;Krahulik et al, 2010). These findings prompted debates as to whether hormonal profile evaluation should be routinely checked in all head injured patients and treated accordingly.…”

Section: Standard Monitoringmentioning

confidence: 99%

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

Idris¹,

Mustapha²,

Abdullah³

2012

Brain Injury - Pathogenesis, Monitoring, Recovery and Management

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Section: Standard Monitoringmentioning

confidence: 99%

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

Idris¹,

Mustapha²,

Abdullah³

2012

Brain Injury - Pathogenesis, Monitoring, Recovery and Management

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“…Post-traumatic hypopituitarism (PTH) has long been described only in case reports. Numerous recent studies have evaluated (mostly retrospectively) the incidence of PTH in adult patients and in children 2,[12][13][14][15]26 . The prevalence of a hormonal dysfunction is, according to the results, highly variable: between 9 and 63% of the adult population and between 10 and 61% in children.…”

Section: Discussionmentioning

confidence: 99%

“…This opinion has changed over the last decade, as numerous studies conducted on adults established the prevalence of post-traumatic hypopituitarism in 23 to 69% of the cases (Table 1) (ref. [9][10][11][12][13][14][15] ). Much less is known about neuroendocrine dysfunctions in the pediatric population than about the adult population.…”

Section: Introductionmentioning

confidence: 99%

Prospective study of hypothalamo-hypophyseal dysfunction in children and adolescents following traumatic brain injury

Krahulík¹,

Aleksijevic²,

Smolka³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background and Aims.Retrospective studies of TBI have found a neuroendocrine dysfunction following traumatic brain injury in 23 to 60% of adults and 15 to 21% of children. Our aims were to determine the prevalence of hypothalamo-hypophyseal dysfunction in children following brain injury, assess its relationship to the type of injury and the course of the acute post-traumatic phase. Patients and Methods. Body development (growth, pubertal development, and skeletal maturity) were evaluated in 58 patients (21 girls) after a brain injury rated 3 to 12 on the Glasgow Coma Scale (GCS). The patients underwent standard endocrine tests -TSH, fT4, IGF-1, PRL, morning cortisol, FSH, LH, and testosterone in boys and estradiol in girls -in the early post-traumatic period (2 to 14 days; T0) and at 3, 6, and 12 months after the injury (T3, T6, and T12). Dynamic tests were carried out in patients with abnormalities in their clinical examination and/or laboratory results. An MRI was performed on all patients at T12. Results. The median age at the time of injury was 11.3 (0.5 to 18.7) years. Of the 58 patients, 23 had GCS < 8, corresponding to severe brain injury. At T0, diabetes insipidus (DI) was diagnosed in 12 patients, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was found in 4 patients. Frequent hormonal changes simulated central hypothyroidism (in 45% of patients) and hypogonadotropic hypogonadism (in 25% of adolescents who were already pubertal at the time of injury > Tanner II). Examination at T3 (n = 58) confirmed a combined pituitary hormone deficiency in two boys and DI in another one. At T6 (n = 49), hormonal dysfunctions were diagnosed in two boys (precocious puberty and growth hormone deficiency). At T12 (n = 39), a new endocrine dysfunction was diagnosed in five patients (growth hormone deficiency in two, hypogonadotropic hypogonadism in two, and in one patient, already diagnosed with a growth hormone deficiency, central hypothyroidism, as well). Brain MRI revealed an empty sella in two patients with growth hormone deficiency. Patients with GCS < 8 had more symptoms of SIADH or DI in the early post-traumatic period 11/23 vs. patients with GCS of 8 to 13 (4/35), and more frequent hormonal disorder (6/23) than individuals with moderate trauma (3/35), P = 0.0135. The incidence of endocrine dysfunction at T0 significantly correlated with the severity of injury (P = 0.05), but it was not an indicator for the development of a late hormonal disorder. Conclusion. Within a year after injury, a hormonal disorder was found in 17.6% of the patients. Neuroendocrine dysfunction as a late consequence of craniocerebral trauma in children and adolescents was less frequent than in adults. Risk factors for its development are the gravity of the injury, brain scan pathology, and possibly the development of DI, SIADH, or CSWS in the acute post-traumatic phase.

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“…The literature contains reported rates of chronic hypopituitarism post-TBI which range from 15% to 69% (3,19,32,33,43,46,47,48,49,50,51,52,53,54,55,56,57,58,59). Published cohort studies vary widely in methods of patient selection, severity of head injury included and the timing and methods of testing for hypopituitarism ( Table 1).…”

Section: Anterior Pituitarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults

Cited by 90 publications

References 20 publications

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

Prospective study of hypothalamo-hypophyseal dysfunction in children and adolescents following traumatic brain injury

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

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