Changes of sympatho-adrenal and hypothalamo-pituitary-adrenocortical system in patients with head injury

• Published in: Acta neurologica Scandinavica Vol. 96; no. 1; pp. 52 - 58
• Main Authors: Kôiv, L, Merisalu, E., Zilmer, K., Tomberg, T., Kaasik, A.-E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.1997; Blackwell
• Subjects: Adolescent; adrenocorticotropic hormone; Adrenocorticotropic Hormone - metabolism; Adult; Biological and medical sciences; Brain Injuries - diagnosis; Brain Injuries - metabolism; brain injury; catecholamines; Cortisol; Epinephrine - metabolism; head injury; Humans; Hydrocortisone - metabolism; Hypothalamo-Hypophyseal System - diagnostic imaging; Hypothalamo-Hypophyseal System - metabolism; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Norepinephrine - metabolism; Pituitary-Adrenal System - diagnostic imaging; Pituitary-Adrenal System - metabolism; prognosis; Radiography; Traumas. Diseases due to physical agents; Human; Nervous system diseases; Prognosis; Venous blood; Sympathoadrenal system; Steroid hormone; Craniocerebral; Diseases of the osteoarticular system; ACTH; Biological marker; Catecholamine; Hydrocortisone; Glucocorticoid; Trauma; Cerebral disorder; Adrenal hormone; Central nervous system disease; Skull disease; Hormonal investigation; Severe; Hypothalamohypophysocorticoadrenal axis
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/j.1600-0404.1997.tb00238.x

To determine the role of the sympatho‐adrenal (SAS) and hypothalamo‐pituitary‐adrenocortical system (HPAS) after head injury, the relationship between venous blood epinephrine (E), norepinephrine (NE), adrenocorticotropic hormone (ACTH), Cortisol levels, and clinical condition was examined in 55 patients. These observations suggest that head injury causes mainly activation of the above‐mentioned systems depending on the severity of trauma. An inverse correlation between the levels of E, NE and Glasgow Coma Scale score, indicating the severity of head injury was revealed. ACTH and Cortisol were similarly related to the clinical condition, although the observed correlation was less expressed. The changes in hormonal levels were present during the whole research period (1 week), although a certain shift to normalization was observed. However, catecholamines and ACTH levels in plasma were relatively low in severely head‐injured patients whose CT scans revealed serious alterations in the mesencephalic‐diencephalic area. At the same time their Cortisol levels obtained maximal values and their chance to survive was diminutive. The results of this study indicate that investigation of hormones of SAS and HPAS might be useful as an additional method in the complex of ordinary examinations in establishing early prognosis in patients with brain injury.