gms | German Medical Science

Objective: Endocrine changes play an important role in the clinical course of patients after severe traumatic brain injury (TBI). These changes may have prognostic relevance for the long-term outcome of the patients. In previous studies it has been shown that gross alterations e.g. hemorrhages and/or ischemic lesions of the cortico-hypothalamic-pituitary-axis seem to matter, however, since similar clinical symptoms are also found in patients without gross lesions, axonal and neuronal lesions also affect the integrity of the endocrine regulation. In the present study, we examined morphological changes in the hypothalamus in correlation with the endocrine status determined by hormonal levels in the blood and the csf of patient that had died after severe TBI.

Methods: In this study 20 brain samples from autopsies of patients that died after TBI were investigated. Patients with open craniocerebral injury were excluded. Samples from 10 different brain regions, including the anterior and posterior hypothalamus, as well as a sample from the adrenal gland were collected, paraffin-embedded and investigated by conventional histology using H&E- and Bodian-silver-staining and immunohistochemistry. In addition, blood and csf were investigated for pathological altered hormonal concentrations.

Results: Using this approach, we observed DAIs, both by conventional histology and by β-APP-immunoreactivity. In addition activated astrocytes and infiltration of microglial cells were detected by GFAP- and CD68-immunoreactivity, respectively

Conclusions: The demonstration of histological alterations in the hypothalamus without any gross lesions of the cortico-hypothalamic-pitury-axis in our study might indicate axonal injury as an important pathogenetic factor in the development of endocrine failure of patients suffering from severe TBI.