title: Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury.
abstract: OBJECTIVE
  Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up.
  
  
  METHODS
  Prospective study at a tertiary university referral centre.
  
  
  METHODS
  A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended.
  
  
  RESULTS
  Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months.
  
  
  CONCLUSIONS
  The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
authors.affiliation: Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
authors.forename: Djordje
authors.initials: D
authors.lastname: Marina
authors.affiliation: Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Klose
authors.affiliation: Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Nordenbo
authors.affiliation: Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Liebach
authors.affiliation: Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark ufeldt@rh.dk.
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000097:blood* / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D042341:Gonadal Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000097:blood*; D013315:Stress, Psychological / Q000097:blood* / Q000209:etiology; D013963:Thyroid Hormones / Q000097:blood*
chemical_list: D042341:Gonadal Hormones; C583557:IGF1 protein, human; D010907:Pituitary Hormones; D013963:Thyroid Hormones; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone