title: Longitudinal sex and stress hormone profiles among reproductive age and post-menopausal women after severe TBI: A case series analysis.
abstract: To describe hormone profiles for pre-/post-menopausal women, to monitor time to resumption of menstruation among pre-menopausal women and to describe cortisol associated LH suppression and phasic variation in other sex hormones over timeMethods and procedures: This study determined amenorrhea duration and characterized acute (days 0-7) and chronic (months 1-6) gonadotropins [luteinizing hormone and follicle stimulating hormone (LH, FSH)], sex hormones (progesterone, estradiol) and stress hormone (cortisol) profiles. Women were pre-menopausal (n = 3) or post-menopausal (n = 3). Among pre-menopausal women, menstrual cycle resolution and phase association (luteal/follicular) was monitored using self-report monthly reproductive history questionnaires. This study compared post-TBI hormone profiles, stratified by menopausal status, to hormone levels from seven controls and described 6- and 12-month outcomes for these women.
  
  
  
  Consistent with functional hypothalamic amenorrhea (FHA), menstruation resumption among pre-menopausal women occurred when serum cortisol normalized to luteal phase control levels. For post-menopausal women, serum cortisol reductions corresponded with resolution of suppressed LH levels.
  
  
  
  The stress of TBI results in anovulation and central hypothalamic-pituitary-ovarian (HPG) axis suppression. Future work will examine acute/chronic consequences of post-TBI hypercortisolemia and associated HPG suppression, the temporal association of HPG suppression with other neuroendocrine adaptations and how HPG suppression impacts multidimensional recovery for women with TBI.
authors.affiliation: a Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Prerna
authors.initials: P
authors.lastname: Ranganathan
authors.affiliation: a Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Raj G
authors.initials: RG
authors.lastname: Kumar
authors.affiliation: a Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Davis
authors.affiliation: a Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Emily H
authors.initials: EH
authors.lastname: McCullough
authors.affiliation: b Department of Obstetrics/Gynecology , Wake Forest University , Winston-Salem , NC , USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Berga
authors.affiliation: a Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.|c University of Pittsburgh, School of Medicine , Pittsburgh , PA , USA.|d Safar Center for Resuscitation Research , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008137:Longitudinal Studies; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017698:Postmenopause; D013997:Time Factors; D055815:Young Adult
chemical_list: D012739:Gonadal Steroid Hormones; D006854:Hydrocortisone
keywords: Hypogonadism; amenorrhea; cortisol; functional hypothalamic amenorrhea; luteal hormone; sex hormone physiology; traumatic brain injury