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Intensive Care Medicine

, Volume 30, Issue 6, pp 1051–1057 | Cite as

Endocrine abnormalities in critical care patients with moderate-to-severe head trauma: incidence, pattern and predisposing factors

  • Ioanna Dimopoulou
  • Stylianos Tsagarakis
  • Maria Theodorakopoulou
  • Evangelia Douka
  • Maria Zervou
  • Andreas T. Kouyialis
  • Nikolaos Thalassinos
  • Charis Roussos
Original

Abstract

Objective

To investigate the incidence and type of endocrine abnormalities in critical care patients with traumatic brain injury (TBI) and to examine their relationships to possible predisposing factors.

Design

Prospective study.

Setting

General intensive care unit in a university hospital.

Patients and participants

Thirty-four TBI patients (27 men, 7 women), having a mean age of 37±16 years, were studied after weaning from mechanical ventilation.

Interventions

Baseline endocrine assessment was carried out by measuring cortisol, corticotropin, dehydroepiandrosterone sulfate, free thyroxine, thyrotropin (TSH), testosterone, oestradiol, follicle stimulating hormone (FSH), luteinizing hormone, prolactin, growth hormone and insulin-like growth factor I. Dynamic evaluation was performed by human corticotropin releasing hormone and growth hormone releasing hormone in all patients. Male patients underwent additional investigation with gonadotropin-releasing hormone. Severity of neurological derangement was graded according to Glasgow Coma Scale (GCS), Marshall Computerized Tomographic Classification and intracranial pressure (ICP) levels.

Measurements and results

Eighteen of the 34 patients (53%) had an abnormal result in at least one hormonal axis tested, with cortisol hyporesponsiveness and gonadal dysfunction being equally common, affecting 24% of patients. Endocrine abnormalities were associated with a higher brain CT-scan classification score (p=0.02). The GCS on admission correlated positively with baseline FSH (r=0.37, p=0.03), peak FSH (r=0.41, p=0.03), testosterone (r=0.44, p=0.02) and TSH (r=0.39, p=0.03). There were no relations between ICPmax and any baseline or dynamic hormone measurements.

Conclusions

Patients with TBI receiving critical care show changes in their neuroendocrine responses, which depend upon clinical and radiological measures of head injury severity. Most common abnormalities include cortisol hyporesponsiveness and hypogonadism.

Keywords

Head trauma Cortisol hyporesponsiveness Hypogonadism Partial growth hormone deficiency Hypothyroidism Marshall Computerized Tomographic Classification 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Ioanna Dimopoulou
    • 1
    • 3
  • Stylianos Tsagarakis
    • 2
  • Maria Theodorakopoulou
    • 1
  • Evangelia Douka
    • 1
  • Maria Zervou
    • 1
  • Andreas T. Kouyialis
    • 1
  • Nikolaos Thalassinos
    • 2
  • Charis Roussos
    • 1
  1. 1.Department of Critical Care MedicineEvangelismos Hospital, National and Kapodistrian University of Athens, Medical SchoolAthensGreece
  2. 2.Department of Endocrinology Diabetes and MetabolismEvangelismos Hospital, National and Kapodistrian University of Athens, Medical SchoolAthensGreece
  3. 3.2 Pesmazoglou Street, 14 561 KifissiaAthensGreece

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