title: The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage.
abstract: Previous reports suggest that neuroendocrine disturbances in patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) may still develop or resolve months or even years after the trauma. We investigated a cohort of n = 168 patients (81 patients after TBI and 87 patients after SAH) in whom hormone levels had been determined at various time points to assess the course and pattern of hormonal insufficiencies. Data were analyzed using three different criteria: (1) patients with lowered basal laboratory values; (2) patients with lowered basal laboratory values or the need for hormone replacement therapy; (3) diagnosis of the treating physician. The first hormonal assessment after a median time of three months after the injury showed lowered hormone laboratory test results in 35% of cases. Lowered testosterone (23.1% of male patients), lowered estradiol (14.3% of female patients) and lowered insulin-like growth factor I (IGF-I) values (12.1%) were most common. Using Criterion 2, a higher prevalence rate of 55.6% of cases was determined, which correlated well with the prevalence rate of 54% of cases using the physicians' diagnosis as the criterion. Intraindividual changes (new onset insufficiency or recovery) were predominantly observed for the somatotropic axis (12.5%), the gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%). Patients after TBI showed more often lowered IGF-I values at first testing, but normal values at follow-up (p < 0.0004). In general, most patients remained stable. Stable hormone results at follow-up were obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin values).
authors.affiliation: Clinical Neuroendocrinology Group, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, Munich 80804, Germany. anna_kopczak@psych.mpg.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Kopczak
authors.affiliation: Schön Klinik Bad Aibling, Kolbermoorer Straße 72, Bad Aibling 83043, Germany. CKrewer@schoen-kliniken.de.
authors.forename: Carmen
authors.initials: C
authors.lastname: Krewer
authors.affiliation: Schön Klinik Bad Aibling, Kolbermoorer Straße 72, Bad Aibling 83043, Germany. MSchneider@schoen-kliniken.de.
authors.forename: Manfred
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Department of Neurosurgery, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany. ilonka.kreitschmann@uk-essen.de.
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
authors.affiliation: Department of Endocrinology, Ludwig-Maximilians-University, Ziemssenstraße 1, Munich 80336, Germany. harald.schneider@med.uni-muenchen.de.
authors.forename: Harald Jörn
authors.initials: HJ
authors.lastname: Schneider
authors.affiliation: Clinical Neuroendocrinology Group, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, Munich 80804, Germany. stalla@psych.mpg.de.
authors.forename: Günter Karl
authors.initials: GK
authors.lastname: Stalla
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000097:blood* / Q000150:complications; D004700:Endocrine System Diseases / Q000097:blood* / Q000453:epidemiology; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D011388:Prolactin
keywords: hypopituitarism; neuroendocrinology; posttraumatic hypopituitarism; subarachnoid hemorrhage; traumatic brain injury