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

Eur J Endocrinol. 2015 Jun;172(6):813-22

Marina D(1), Klose M(1), Nordenbo A(1), Liebach A(1), Feldt-Rasmussen U(2)

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, n=111) or non-TBI (n=52) 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.

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