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

Abstract

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.

Sex-dependent macromolecule and nanoparticle delivery in experimental brain injury

“…A pre-clinical rat study shows evidence that TBI leads to disruption of the estrous cycle with significantly reduced 17ߚ-estradiol (E2) hormone level 71 and spatial memory impairment compared to the sham group. Similarly, clinical studies indicate that TBI affects the circulating serum hormone levels in both females and males 72,73 . In females, testosterone increased with modest/no increase in estrogens 72 .…”

“…In females, testosterone increased with modest/no increase in estrogens 72 . In males, estrogen increases with a decrease in testosterone 73 . Therefore, specific studies to understand the role of sex hormones in neuroprotection and BBB breakdown after TBI are warranted.…”

Sex-Dependent Macromolecule and Nanoparticle Delivery in Experimental Brain Injury

“…Similarly, clinical studies indicate that TBI affects the circulating serum hormone levels in both females and males. 57,60 In females, testosterone increased with modest/no increase in estrogens. 57 In males, estrogen increases with a decrease in testosterone.…”

“…57 In males, estrogen increases with a decrease in testosterone. 60 Therefore, comprehensive studies to understand the specific mechanism that drives the pathophysiological changes and the role of sex hormones in neuroprotection and BBB breakdown after TBI are warranted.…”

Sex Differences in Sex Hormone Profiles and Prediction of Consciousness Recovery After Severe Traumatic Brain Injury

“…Furthermore, there is proof that estrogen and progesterone have neuro-protective effects, suggesting that inadequate levels may have both acute and long-term consequences on the recovering brain (9). Decades of studies show that testosterone levels are low in 36.5–100% of patients with sTBI, however, the prognostic significance of testosterone levels remains controversial (10). Although insufficiency in hormones after TBI has become increasingly recognized, there are limited data focusing on TBI survivors regarding the role of sex hormones in predicting consciousness.…”