The secretion of human growth hormone stimulated by human growth hormone releasing factor following severe cranio-cerebral trauma

Abstract

Patients suffering from severe cranio-cerebral trauma show alterations of the secretory patterns of thyroid stimulating hormone (TSH) and human growth hormone (HGH) which may be of prognostic significance. We studied 10 patients following severe brain injury and prospectively compared a new synthetic human growth hormone releasing factor (HGHRF) test with the thyrotropin releasing hormone (TRH) test. On admission, all patients had a Glasgow Coma Scale score of 3 or 4. All patients had a low T3 syndrome. In the patients who died the TSH response after stimulation with TRH was also absent. In the patients who survived a significant TSH increase was observed (p less than 0.05). In comparison to the patients who died those who survived showed a significant (p less than 0.001) HGH increase after HGHRF stimulation. This test might be useful as an additional tool in establishing early prognosis in patients with severe brain injury.

Hypopituitarism after traumatic brain injury

“…In this regard, only a few authors have evaluated the relationship between outcome from TBI and the presence of pituitary dysfunction. As mentioned above, either positive or negative relationships between pituitary dysfunction and outcome from TBI have been observed in the early, acute phase post-TBI (41,46,47,61). We did not find any statistical correlation between outcome measures and presence of pituitary dysfunction, both in patients examined over a 5-year period after TBI (5) and in patients evaluated during the early rehabilitation period (48).…”

“…A blunted GH response to arginine (ARG) stimulation has been found in patients with severe TBI and very poor outcome (41). Gottardis et al (46) reported that a GH-releasing hormone (GHRH) test elicited a significant (43). These data indicate an imbalance of the complex neuroendocrine system controlling GH secretion during the acute phase post-TBI, but they do not draw reliable conclusions.…”

Neuroendocrine Disturbances Following Head Injuries

“…As mentioned above, either positive or negative relationships between pituitary dysfunction and outcome from TBI have been observed in the early, acute phase post-TBI. (39,40,41,42) We did not find any statistical correlation between outcome measures and presence of pituitary dysfunction, both in patients examined over a 5-years period after TBI (5) and in patients evaluated during the early rehabilitation period. (43) Autopsy studies demonstrated a high incidence (14-74%) of anatomical lesions in the hypothalamic-pituitary region; this suggests, therefore, that hypopituitarism might contribute to the poor prognosis of the TBI patients.…”

Anterior Pituitary Hormone Abnormalities following Traumatic Brain Injury

“…A blunted GH response to GHRH administration has been found to be associated with increased mortality (Gottardis et al, 1990).…”

“…TSH responses to thyroid-releasing hormone (TRH) are variable (Eledrisi et al, 2001). An absent TSH response to TRH has been shown to be associated with high mortality (Gottardis et al, 1990).…”