Significance of Endocrine Studies in the General Assessment and Prediction of Fatal Outcome in Head Injury

Pentelényi, T

doi:10.1007/978-3-7091-9233-7_7

Cited by 13 publications

(8 citation statements)

References 10 publications

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“…This concurs with the results of Penteleny et al 28 who found that, in patients with head injuries, a fatal outcome could be predicted within the first days if an over-activation of the pituitary-adrenal axis was present. In agreement with these reports, our study reveals low plasma ACTH levels 2 days after TBI in 60% of the patients.…”

Section: Relationship Between Plasma Acth and Survival In Tbisupporting

confidence: 92%

Relationship Between Plasma Adrenocorticotropin Hormone and Intensive Care Unit Survival in Early Traumatic Brain Injury

Llompart‐Pou

Raurich

Ibáñez

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Section: Relationship Between Plasma Acth and Survival In Tbisupporting

confidence: 92%

Relationship Between Plasma Adrenocorticotropin Hormone and Intensive Care Unit Survival in Early Traumatic Brain Injury

Llompart‐Pou

Raurich

Ibáñez

et al. 2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…However, published reports on cortisol changes in critically injured patients are inconsistent and somewhat controversial. While Munno et al [35] have shown depressed cortisol levels in patients with vegetative state and those emerging from coma, Pentelenyi [36] suggest that persistently high levels of cortisol and glucose in blood of braininjured patients portend a fatal outcome. The data show enhanced serum cortisol in all neurotrauma patients immediately (<3 h) after injury which suggests a profound activation of the hypothalamic-pituitary-adrenal axis by injury.…”

Section: Discussionmentioning

confidence: 99%

Neuroendocrine responses following graded traumatic brain injury in male adults

Černak

Savic²,

Lazarov³

et al. 1999

Brain Injury

126

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In an effort to characterize thyroid, gonadal and adrenal function following neurotrauma, the present study determined serum concentrations of thyroid-stimulating hormone (TSH), total triiodothyronine (T3), thyroxine (T4), testosterone and cortisol over a 7 day period in 31 patients with traumatic brain injury. The study group consisted of eight patients with mild closed head injury (Glasgow Coma Scale--GCS 13-15), 10 patients with extensive penetrating head injury (GCS 4-6) and 13 patients with blast injuries but without direct head trauma. The latter group was included in the study because the development of indirect brain trauma has previously been implicated in blast injuries. Patients with multiple injuries were not included. Following mild injury (GCS 13-15), TSH was increased up until day 3 after injury. T3 levels were elevated on days 1, 5 and 7 after injury while T4 remained unchanged throughout. While testosterone was decreased over only the first 2 days post-trauma, cortisol was increased over these first 2 days after injury. In contrast, following severe penetrating injury (GCS 4-6), there were significant declines in TSH, T3 and testosterone over the 7 day observation period post-trauma. Serum cortisol also declined in these patients between 1-3 days after injury, before increasing again on days 5 and 7 after injury. Following indirect neurotrauma, TSH was slightly decreased immediately after trauma but increased to above normal levels on days 5 and 7 post-trauma. Similarly, T3 initially declined after injury, but then increased to above normal levels between 5 and 7 days after injury. T4 and testosterone remained unchanged over the entire post-traumatic period. Serum cortisol was significantly increased after indirect neurotrauma but only up to day 2 post-trauma. In summary, patients with both direct and indirect traumatic brain injury demonstrated endocrine alterations after trauma, the dynamics of which may be a reflection of the severity of brain damage.

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“…20,32,57 The variability in such studies may relate to the high physiological stress associated with trauma and emergency pharmacological interventions. Regarding the findings of this study, it is acknowledged that the true rate of posttraumatic hypopituitarism may be overestimated because of the small sample size.…”

Section: Study Design and Potential Selection Biasmentioning

confidence: 99%

Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report

Kelly¹,

Gonzalo²,

Cohan³

et al. 2000

Journal of Neurosurgery

406

386

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From this preliminary study, some degree of hypopituitarism appears to occur in approximately 40% of patients with moderate or severe head injury, with GH and gonadotroph deficiencies being most common. A high degree of injury severity and secondary cerebral insults are likely risk factors for hypopituitarism. Pituitary dysfunction also occurs in patients with poor-grade aneurysms. Postacute pituitary function testing may be warranted in most patients with moderate or severe head injury, particularly those with diffuse brain swelling and those sustaining hypotensive or hypoxic insults. The neurobehavioral effects of GH replacement in patients suffering from head injury or SAH warrant further study.

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Significance of Endocrine Studies in the General Assessment and Prediction of Fatal Outcome in Head Injury

Cited by 13 publications

References 10 publications

Relationship Between Plasma Adrenocorticotropin Hormone and Intensive Care Unit Survival in Early Traumatic Brain Injury

Relationship Between Plasma Adrenocorticotropin Hormone and Intensive Care Unit Survival in Early Traumatic Brain Injury

Neuroendocrine responses following graded traumatic brain injury in male adults

Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report

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