Endocrine changes in patients recovering from acute traumatic or nontraumatic brain injury: pattern and correlations with functional outcome

To clarify endocrine derangements in patients recovering from traumatic or nontraumatic brain injury (BI), 40 patients (31 men) having a mean age of 47 ± 17 years were investigated. BI was due to spontaneous intracerebral hemorrhage (n = 16), trauma (n = 16), ischemic stroke (n = 7) or ruptured brain aneurysm (n = 1). The median Glasgow Coma Score on admission in the ICU was 8 and the duration of mechanical ventilation ranged from 2 to 120 days. Patients were enrolled in the study after being transferred in the rehabilitation unit. Hormonal assessment included the measurement of thyroxine (T4), tri-iodothyronine (T3), thyrotropin (TSH), cortisol, corticotropin (ACTH), prolactin, testosterone, estradiol, insulin-like growth factor I (IGF-1), and dehydroepiadrosterone sulphate (DHEAS). Functional outcome was assessed with the Glasgow Outcome Scale (GOS). In the entire patient population several endocrine abnormalities were observed, including low T3 (n = 5), low T4 (n = 5), high TSH (n = 6) or low TSH (n = 1), high cortisol (n = 4), low ACTH (n = 4) or high ACTH (n = 8), high prolactin (n = 15), low testosterone (n = 11), low IGF-1 (n = 15), and low DHEAS (n = 10). None of the patients had cortisol levels below the local reference range for unstressed individuals. The GOS ranged from 1 to 5 and its distribution was as follows: GOS of 1 (n = 4), GOS of 2 (n = 15), GOS of 3 (n = 11), GOS of 4 (n = 5), and GOS of 5 (n = 5). There were significant correlations between GOS and T3 (r = 0.44, P = 0.005), T4 (r = 0.35, P = 0.02), ACTH (r = 0.43, P = 0.007) and DHEAS (r = 0.34, P = 0.03). In contrast, GOS did not correlate with TSH, cortisol, prolactin, testosterone, estradiol or IGF-1 levels.

To conclude, endocrine abnormalities are common in patients recovering from acute traumatic or nontraumatic BI and are related to patients' functional outcome. It remains to be defined whether such hormonal changes are adaptive or reflect pathology.