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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Article

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Pituitary function in patients with CNS injury

Hypophysenfunktion bei Patienten mit Verletzungen des ZNS

Meeting Abstract

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  • S. Tomé - Neurochirurgische Klinik der RWTH Aachen
  • corresponding author F.-J. Hans - Neurochirurgische Klinik der RWTH Aachen
  • G. Schälte - Anästhesiologische Klinik der RWTH Aachen
  • S. Bertig - Neurochirurgische Klinik der RWTH Aachen
  • A. Fey - Neurochirurgische Klinik der RWTH Aachen
  • E. Uhl - Neurochirurgische Klinik der LMU München

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-13.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0060.shtml

Published: May 4, 2005

© 2005 Tomé et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

Pituitary insufficiency during long-term follow-up after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) has become of increasing interest during the last years. There exist, however, only limited data on pituitary function during the acute setting on the intensive care unit (ICU). Aim of the current study was to evaluate pituitary function of patients with SAH, TBI and intracerebral hemorrhage (ICH) shortly after the insult and at discharge from the intensive care unit.

Methods

Intubated patients with SAH, TBI and ICB (initial median GCS 9) admitted to the intensive care unit were evaluated. Serum levels of thyroid hormones (fT3, fT4, TSH), prolactin, antidiuretic hormone (ADH), morning cortisol, ACTH, IGF-1, testosterone, oestradiol and FSH were measured within 24h after admittance to and at discharge from the ICU.

Results

100 patients (SAH:36, TBI: 41, ICH: 23) were evaluated. The most common change shortly after the insult was a decrease of IGF-I in 36.1% of all patients, an increase of prolactin in 46.7% and of ADH in 44.0% (decrease of ADH: 14.7%) of the cases. Disturbances of the gonadotrope, thyreotrope and corticotrope axis were less frequent. In surviving patients (n=79) somatotrope distuburances decreased from 33.3% initially to 16% of the patients at discharge. Prolactin was increased in 40.6% of the survivors on admittance. This number decreased to 34% at discharge. Serum levels of ADH were less homogenous distributed. ADH was found to be low in 14.1% and increased in 45.1% of surviving patients shortly after injury. At discharge (median 20 days after admittance to the ICU) ADH was low in 31.0% and increased in 20.7% of all patients.

Conclusions

Our preliminary data show that disturbances of pituitary function occur already early after injury to the CNS. All pituitary hormones were affected to a different degree with prolactin, ADH and IGF-1 being the most frequent ones. Changes of these disturbances, especially of ADH and IGF-1, occur already during the stay on the ICU. Whether pituitary dysfunction may be of prognostic importance and which type of injuries lead to endocrinological disturbances remains to be elucidated.