Neuroendocrine consequences of traumatic brain injury

Munoz, Alejandro; Urban, Randall J.

doi:10.1097/med.0b013e32836318ba

Cited by 19 publications

(13 citation statements)

References 27 publications

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“…Neuroendocrine dysfunction is prevalent in approximately two-thirds of people with TBI. Having been shown to result in a complex cascade of pathophysiological and neurochemical events, TBI concerns adversities towards both recovery and stress level, and therefore warrants attention [36, 37]. Disruption of neural connections between the cerebral cortex and the brainstem due to TBI frequently impairs bladder control [38].…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

et al. 2017

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ObjectiveComorbid disorders influence the course and outcomes of rehabilitation following traumatic brain injury (TBI), yet sex- and age-related disparities in the frequency distribution of these disorders remain poorly understood. We aimed to describe comorbid disorders by the International Classification of Diseases in patients with TBI undergoing inpatient rehabilitation in Ontario, Canada over a 3-year period, by sex and age, and discuss their potential impact on rehabilitation outcomes.ResultsThe percentage of TBI patients with one or more comorbid disorder is higher among older (≥65 years) men and women than among those who are younger or middle-aged (<65 years). Among younger and middle-aged patients, multiple injuries and trauma, mental health conditions, and nervous system disorders were the most prevalent comorbidities. In older patients, circulatory, endocrine, nutritional, metabolic, and immune disorders were the most prevalent comorbidities. Our results suggest that a multisystem view of rehabilitation of men and women with TBI across age categories is needed to reflect the complex clinical profile of TBI patients undergoing rehabilitation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2682-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

et al. 2017

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“…The process of DAI explains much of the long term cognitive dysfunction following TBI [ 14 ]. Disturbances of attention, memory, and executive functioning are the most common neurocognitive consequences associated with this process [ 14 , 15 ].…”

Section: Mechanism Of Injury During Traumatic Brain Injuriesmentioning

confidence: 99%

“…The most common pituitary abnormality was GHD, followed by hypogonadism. In studies of endocrine deficiencies following TBI in adults, patient selection and dissimilar methodologies accounted for variations in overall prevalence and influenced the incidence of abnormality detected [ 15 , 22 ]. However, given the high incidence of TBI, even relatively low occurrence of endocrine deficiency would translate into a large number of individuals developing hypopituitarism after TBI.…”

Section: Incidence Of Endocrine Changes Following Tbi: Adult Litermentioning

confidence: 99%

“…In GH-treated TBI survivors enrolled in a placebo-controlled study of GH therapy, cognitive function improved including processing speed, short-term memory, and executive function [ 26 , 27 ]. Thus, GHD may explain common complaints reported by recovering individuals including fatigue and cognitive challenges [ 15 ].…”

Section: Incidence Of Endocrine Changes Following Tbi: Adult Litermentioning

confidence: 99%

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Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury

Reifschneider

Auble

Rose

2015

JCM

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Traumatic brain injuries (TBI) are common occurrences in childhood, often resulting in long term, life altering consequences. Research into endocrine sequelae following injury has gained attention; however, there are few studies in children. This paper reviews the pathophysiology and current literature documenting risk for endocrine dysfunction in children suffering from TBI. Primary injury following TBI often results in disruption of the hypothalamic-pituitary-adrenal axis and antidiuretic hormone production and release, with implications for both acute management and survival. Secondary injuries, occurring hours to weeks after TBI, result in both temporary and permanent alterations in pituitary function. At five years after moderate to severe TBI, nearly 30% of children suffer from hypopituitarism. Growth hormone deficiency and disturbances in puberty are the most common; however, any part of the hypothalamic-pituitary axis can be affected. In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children’s quality of life both acutely and chronically. Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances. High indices of suspicion for life threatening endocrine deficiencies should be maintained during acute care. Additionally, survivors of TBI should undergo endocrine surveillance by 6–12 months after injury, and then yearly, to ensure early detection of deficiencies in hormonal production that can substantially influence growth, puberty and quality of life.

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“…However, in presence of normal IGF-I values, a provocative test is mandatory in order to confirm or exclude the GHD (21,22). In the last years many authors have demonstrated that hypopituitarism, in particular GHD, is common among patients that have suffered from a traumatic brain injury, and the prevalence may vary from 10 to 25% (23,24). In an interesting study in a series of patients with a documented history of moderate to severe traumatic brain injury the role of low IGF-I value to determine with a better accuracy the patients needing a screening for GHD has been emphasized (25).…”

Section: Ghd Symptomsmentioning

confidence: 99%

Adult GH deficiency - the value of IGF-I estimation

Boschetti¹

2013

REM

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SummaryIn patients with growth hormone (GH) deficiency (GHD) the diagnostic value of IGF-I levels has been recently revisited. A normal IGF-I value does not exclude GHD, because its secretion is complex and depends by several factors other than GH, such as age, nutritional status, obesity, as well as catabolic illness. Due to the complexity and costs of GH stimulation tests, several authors have analyzed the predictive and diagnostic value of the concentration of plasma IGF-I in patients suspected for GHD. The evaluation of IGF-I is also determinant to individualized dose-titration strategies, able to avoid the common adult side effects of substitutive therapy with recombinant GH. Current recommendations in clinical practice for GH replacement therapy, in GHD adults, agree on GH dosing regimens to be individualized independently of body weight using IGF-I levels as a biomarker of the treatment. For these reasons, in a clinical setting, appropriate normative values in different age groups in a large healthy population must be established in single laboratories, while, considering the relatively small sex difference, a different reference range for sex seems not necessary. This review discusses the more recent debated issues in the literature on the role of IGF-I, as well as other IGF system components, in the management of adult patients with GHD.

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Neuroendocrine consequences of traumatic brain injury

Abstract: Pituitary dysfunction is prevalent following TBI. Pituitary dysfunction seems to influence functional outcomes in some patients recovering from brain injury. Adequately selected patients could benefit from hormonal replacement.

Cited by 19 publications

References 27 publications

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes

Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury

Adult GH deficiency - the value of IGF-I estimation

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