Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury

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, nZ111) or non-TBI (nZ52) 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.

Diffuse traumatic brain injury affects chronic corticosterone function in the rat

“…TSH is a glycoprotein hormone secreted in the anterior pituitary and is responsible for stimulating metabolism of tissue throughout the body. Decreased TSH, referred to as hypothyroidism, results in weight gain, and is a common symptom of TBI survivors (15, 62, 63, 64). In a prospective study assessing functional outcome in patients with TBI, 32% presented hypothyroidism at 3months postinjury (62).…”

“…Decreased TSH, referred to as hypothyroidism, results in weight gain, and is a common symptom of TBI survivors (15, 62, 63, 64). In a prospective study assessing functional outcome in patients with TBI, 32% presented hypothyroidism at 3months postinjury (62). This parallels a longitudinal follow-up of adults with TBI showed over a median period of 38months, 42% of TBI patients had gained weight (65).…”

Pre‐traumatic conditions can influence cortisol levels before and after a brain injury

“…Marina et al found in their study that endocrine alterations measured at a median of 3.3 (range 2.1‐4.9) months after an acquired severe brain injury reflected prolonged stress and were related to poorer one‐year functional outcome in patients with a severe brain injury . Baseline cortisol levels did not differ between patients with TBI and controls, but elevated stress hormones (eg, 30‐min stimulated cortisol, prolactin, and/or IGF1) and suppressed gonadal and/or thyroid function were concomitantly recorded in 68% of the patients three months after the injury.…”

“…Baseline cortisol levels did not differ between patients with TBI and controls, but elevated stress hormones (eg, 30‐min stimulated cortisol, prolactin, and/or IGF1) and suppressed gonadal and/or thyroid function were concomitantly recorded in 68% of the patients three months after the injury. They suggested that endocrine alterations, similar to secondary hypogonadism and hypothyroidism, after an acquired severe brain injury most probably reflected a prolonged stress response rather than pituitary insufficiency per se …”

“…They suggested that endocrine alterations, similar to secondary hypogonadism and hypothyroidism, after an acquired severe brain injury most probably reflected a prolonged stress response rather than pituitary insufficiency per se. 13 Hair cortisol measurement is a feasible method to evaluate changes in cortisol. Moreover, cortisol could be influenced by various treatments applied during NICU stay.…”