High prevalence of endocrine disturbances in patients after traumatic brain injury during early rehabilitation

• Published in: Experimental and Clinical Endocrinology & Diabetes
• Main Authors: Seufert, J, Laubner, K, Steube, D
• Format: Conference Proceeding
• Language: English
• Published: 28.02.2006
• ISSN: 0947-7349; 1439-3646
• DOI: 10.1055/s-2006-932871

Objectives: Endocrine changes after traumatic brain injury (TBI) frequently remain unrecognized due to nonspecific clinical symptoms and masking by TBI sequelae. Early diagnosis and adequate hormone replacement therapy, however, are important to prevent endocrine emergencies and improve rehabilitation. Methods: Serum endocrine parameters were analysed at baseline in 145 consecutive TBI patients (106 male, age range 14–93) (39 female, age range 16–89) on admission for early neurological rehabilitation 5–303 days after the TBI accident (closed TBI 85, closed TBI with subarachnoidal hemorrhage 43, penetrating TBI 10, and penetrating TBI with subarachnoidal hemorrhage 7). Parameters were serum cortisol (C), prolactin (P), free thyroxine (fT4), insulin-like growth factor 1 (IGF-1), testosterone (T) and estradiol (E2). Results: 93% of patients (135) displayed one or more pathological hormone result. Overall in 169 analyses hormone parameters were elevated and in 87 analyses serum levels were reduced. Among elevated parameters the most frequent were serum C (90), followed by P (33), fT4 (25), IGF-1 (18) and sex hormones (3). Serum levels of sex hormones (56) were most frequently reduced, followed by IGF-1 (23), fT4 (6) and C (2). Reduced levels of P were never detected. 56 patients displayed only one (46 elevated, 10 reduced), 47 two, 26 three and 8 four pathological hormone parameters of the pituitary axes. Conclusion: Hormonal disturbances are detected at a high prevalence during early rehabilitation for TBI. Except for P, elevated serum levels of hormones may reflect potentially reversible injury-stress related activation of the pituitary axes persistent during early rehabilitation. Reduced serum concentrations may indicate persistent long term hormone insufficiency and warrant further dynamic functional endocrine testing to start hormone replacement if necessary. These results argue for both baseline screening for hormone parameters to identify TBI patients at risk and sequential or functional endocrine testing during the course of rehabilitation.