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Schlagwörter:
hypopituitarism, traumatic brain injury, subarachnoid hemmorrhage, neuroendocrinology, posttraumatic hypopituitarism
Zusammenfassung:
Previous reports suggest that neuroendocrine disturbances in patients
with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage
(SAH) may still develop or resolve months or even years after the
trauma. We investigated a cohort of n = 168 patients (81 patients after
TBI and 87 patients after SAH) in whom hormone levels had been
determined at various time points to assess the course and pattern of
hormonal insufficiencies. Data were analyzed using three different
criteria: (1) patients with lowered basal laboratory values; (2)
patients with lowered basal laboratory values or the need for hormone
replacement therapy; (3) diagnosis of the treating physician. The first
hormonal assessment after a median time of three months after the injury
showed lowered hormone laboratory test results in 35% of cases. Lowered
testosterone (23.1% of male patients), lowered estradiol (14.3% of
female patients) and lowered insulin-like growth factor I (IGF-I) values
(12.1%) were most common. Using Criterion 2, a higher prevalence rate of
55.6% of cases was determined, which correlated well with the prevalence
rate of 54% of cases using the physicians' diagnosis as the criterion.
Intraindividual changes (new onset insufficiency or recovery) were
predominantly observed for the somatotropic axis (12.5%), the
gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%).
Patients after TBI showed more often lowered IGF-I values at first
testing, but normal values at follow-up (p < 0.0004). In general, most
patients remained stable. Stable hormone results at follow-up were
obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin
values).
