A clinical and pathophysiological approach to traumatic brain injury-induced pituitary dysfunction

Temizkan, Şule; Keleştimur, Fahrettin

doi:10.1007/s11102-019-00941-3

Cited by 14 publications

(15 citation statements)

References 75 publications

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“…El trauma craneano directo genera lesión cerebral difusa por la colisión del cerebro con la estructura craneal, el mecanismo de choque y contrachoque, lo que explica la lesión cerebral por el impacto con estructuras óseas situadas en el lado opuesto del trauma primario, el sangrado o el hematoma por ruptura de vasos, que afectan de manera indirecta o directa a la hipófisis o el hipotálamo. Los mecanismos secundarios al trauma, derivados de la lesión primaria, incluyen: hipertensión arterial, hipertensión intracraneal, hipertermia, hipo e hipernatremia, hipoxia, hipotensión y anemia por sangrado, todos son fenómenos que pueden generar muerte neuronal a través de diferentes procesos con generación de radicales libres, estrés oxidativo y aumento de aminoácidos excitatorios como glutamato, lactato y adenosina (1,2,19,26,28,38,43,45,48,49,55).…”

Section: Resultados ¿Cuántos Pacientes Con Trauma Craneoencefálico Pr...unclassified

“…La fase inicial del trauma genera alteraciones funcionales hipofisarias compensatorias con aumento o disminución en los niveles hormonales, sin manifestaciones clínicas notorias o específicas que pueden traslaparse con la clínica del trauma o manifestarse de manera tardía; el edema cerebral e hipofisiario restringe el flujo sanguíneo en los vasos portales, llevando a isquemia, lo que puede evolucionar a necrosis o hemorragia (1,2,19,26,28,38,43,45,48,49,55). Estudios de pacientes con HPPT han mostrado que los principales hallazgos imagenológicos son hemorragia del hipotálamo en el 29 % de los casos y hemorragia hipofisiaria en el 26,3 % de ellos; sumado a esto, los hallazgos histológicos en autopsias dados por hemorragia, trombosis y fibrosis perihipofisiaria/ capsular anterior se observan en el 57,8 % de los casos, la hemorragia del tallo hipofisiario en el 27,4 %, la necrosis del lóbulo anterior en el 21,6 % y ka hemorragia del lóbulo posterior en el 19,6 % (1, 2, 33).…”

Section: Resultados ¿Cuántos Pacientes Con Trauma Craneoencefálico Pr...unclassified

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Alteraciones hipofisiarias postraumáticas y trastornos cognitivos

Tovar

Rubiano

Jiménez-Cañizales

2023

Rev.ACE

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Contexto: el trauma craneoencefálico (TCE) es un problema de salud pública con secuelas neurológicas y cognitivas severas que pueden asociarse a disfunción endocrina hipofisiaria. El compromiso hipofisiario aumenta su morbimortalidad y según el eje hormonal afectado se presentan repercusiones cognitivas y neuroconductuales variables que afectan el proceso de rehabilitación y el reintegro a la vida social de los sobrevivientes. Objetivo: realizar una revisión exploratoria de la literatura sobre la relación que existe entre las alteraciones hormonales hipofisiarias y las alteraciones neurocognitivas posteriores al trauma craneoencefálico. Métodos: se realizó una búsqueda de la literatura para dar respuesta a la pregunta: ¿cuáles alteraciones neurocognitivas se asocian a disfunción hipofisiaria después de un trauma craneoencefálico? Se usaron los descriptores: hipófisis, hipopituitarismo, trauma craneoencefálico, disfunción cognitiva en las bases de datos PubMed® y Scopus; además, se planteó la misma pregunta por cada uno de los ejes hipofisiarios. Resultados: se encontraron un total de 48 artículos en las bases de datos descritas principalmente documentos de tipo descriptivo. Conclusión: la incidencia de alteraciones hormonales hipofisiarias después de un trauma craneoencefálico son frecuentes y existe una posible relación con cambios cognitivos posteriores, por ello deben sospecharse y estudiarse. Siempre se debe interrogar sobre el diagnóstico de una disfunción hipofisiaria a los pacientes con TCE y alteraciones neurocognitivas.

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Section: Resultados ¿Cuántos Pacientes Con Trauma Craneoencefálico Pr...unclassified

Alteraciones hipofisiarias postraumáticas y trastornos cognitivos

Tovar

Rubiano

Jiménez-Cañizales

2023

Rev.ACE

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“…Turkey was the only country that reported on neuroendocrine issues related to concussion injuries. The research in this area was abundant, especially pointing to mTBI in chronic head trauma in boxing, with altered pituitary function, low levels of growth hormones and a small size pituitary (Temizkan et al, 2019;Hacioglu et al, 2019). On the other hand, Iranian researchers were interested in post-traumatic headache in athletes (Jahani et al, 2016) concluding that its incidence was low unless the sport was wrestling, and that post-traumatic headache was an indicator for post-concussion recovery.…”

Section: Resultsmentioning

confidence: 99%

A Perspective From the Middle East on the Topic of Concussion

Chemali¹,

Ezzeddine²,

Tcheroyan³

et al. 2020

GJHS

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Background: Concussion is the most prevalent form of traumatic brain injury. Western countries debate it as a public health issue. Middle Eastern (ME) countries lag behind with a concussion incidence surveillance of 25% that of European countries. Objective: The purpose of our study was to review concussion resulting from traumatic brain or sports injuries in civilian nationals of the ME. Methods: We carried out PubMed literature search of all related articles in the past thirty years using search terms reflecting concussion and sports injuries in ME countries of Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Syria, Turkey, United Arab Emirates, and Yemen. Results: 72 articles met our search criteria with relatively little data found on concussion within the parameters of this review. However, the reports that were found were diverse. Israel, Turkey and Iran led in publications. Motor vehicle accidents were the leading cause of concussion from TBI (50-57%) followed by domestic injuries (30-40%) and sports injuries at 4-7%. Extremity injuries were most commonly reported unlike head injuries often invisible and underreported. Male gender, young children, pedestrian and car traffic accidents, lack of protective gear, cell phone use, impulsive behaviors as well as training overload, lack of sleep, contact sports and violence were all risk factors for concussion. Conclusions: In this review, we highlighted the nascent topic of concussion in the ME and the need for additional research dictating awareness programs and implementing new safety policies to lower morbidity and mortality across all ages.

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“…Hypoxic stress is also a good research model for the involvement of stem cells and OPCs in cell development, proliferation, and differentiation ( 30 , 34 , 54 ). Hypoxic insult is the proposed mechanism of pituitary dysfunction after traumatic brain injury in humans with severe anemia, hypotension, or hypoxia ( 4 , 30 , 55 , 56 ). Tp53 has been reported to be involved in normal somatotroph apoptosis ( 57 , 58 ), but Tp53 mutation does not occur in pituitary adenomas.…”

Section: Discussionmentioning

confidence: 99%

CRHR1 mediates the transcriptional expression of pituitary hormones and their receptors under hypoxia

et al. 2022

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Hypothalamus-pituitary-adrenal (HPA) axis plays critical roles in stress responses under challenging conditions such as hypoxia, via regulating gene expression and integrating activities of hypothalamus-pituitary-targets cells. However, the transcriptional regulatory mechanisms and signaling pathways of hypoxic stress in the pituitary remain to be defined. Here, we report that hypoxia induced dynamic changes in the transcription factors, hormones, and their receptors in the adult rat pituitary. Hypoxia-inducible factors (HIFs), oxidative phosphorylation, and cAMP signaling pathways were all differentially enriched in genes induced by hypoxic stress. In the pituitary gene network, hypoxia activated c-Fos and HIFs with specific pituitary transcription factors (Prop1), targeting the promoters of hormones and their receptors. HIF and its related signaling pathways can be a promising biomarker during acute or constant hypoxia. Hypoxia stimulated the transcription of marker genes for microglia, chemokines, and cytokine receptors of the inflammatory response. Corticotropin-releasing hormone receptor 1 (CRHR1) mediated the transcription of Pomc, Sstr2, and Hif2a, and regulated the function of HPA axis. Together with HIF, c-Fos initiated and modulated dynamic changes in the transcription of hormones and their receptors. The receptors were also implicated in the regulation of functions of target cells in the pituitary network under hypoxic stress. CRHR1 played an integrative role in the hypothalamus-pituitary-target axes. This study provides new evidence for CRHR1 involved changes of hormones, receptors, signaling molecules and pathways in the pituitary induced by hypoxia.

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A clinical and pathophysiological approach to traumatic brain injury-induced pituitary dysfunction

Cited by 14 publications

References 75 publications

Alteraciones hipofisiarias postraumáticas y trastornos cognitivos

Alteraciones hipofisiarias postraumáticas y trastornos cognitivos

A Perspective From the Middle East on the Topic of Concussion

CRHR1 mediates the transcriptional expression of pituitary hormones and their receptors under hypoxia

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