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Acute Gonadotroph and Somatotroph Hormonal Suppression after Traumatic Brain Injury

Wagner, Justin, Dusick, Joshua R., McArthur, David L., Cohan, Pejman, Wang, Christina, Swerdloff, Ronald, Boscardin, W. John, Kelly, Daniel F.·2010·Journal of Neurotrauma
DOI 10.1089/neu.2009.1092
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Abstract

Hormonal dysfunction is a known consequence of moderate and severe traumatic brain injury (TBI). In this study we determined the incidence, time course, and clinical correlates of acute post-TBI gonadotroph and somatotroph dysfunction. Patients had daily measurement of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, estradiol, growth hormone, and insulin-like growth factor-1 (IGF-1) for up to 10 days post-injury. Values below the fifth percentile of a healthy cohort were considered abnormal, as were non-measurable growth hormone (GH) values. Outcome measures were frequency and time course of hormonal suppression, injury characteristics, and Glasgow Outcome Scale (GOS) score. The cohort consisted of 101 patients (82% males; mean age 35 years; Glasgow Coma Scale [GCS] score ≤8 in 87%). In men, 100% had at least one low testosterone value, and 93% of all values were low; in premenopausal women, 43% had at least one low estradiol value, and 39% of all values were low. Non-measurable GH levels occurred in 38% of patients, while low IGF-1 levels were observed in 77% of patients, but tended to normalize within 10 days. Multivariate analysis revealed associations of younger age with low FSH and low IGF-1, acute anemia with low IGF-1, and older age and higher body mass index (BMI) with low GH. Hormonal suppression was not predictive of GOS score. These results indicate that within 10 days of complicated mild, moderate, and severe TBI, testosterone suppression occurs in all men and estrogen suppression occurs in over 40% of women. Transient somatotroph suppression occurs in over 75% of patients. Although this acute neuroendocrine dysfunction may not be TBI-specific, low gonadal steroids, IGF-1, and GH may be important given their putative neuroprotective functions.

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Cited by

Metadata

Authors
Wagner, J., Dusick, J. R., McArthur, D. L., Cohan, P., Wang, C., Swerdloff, R., Boscardin, W. J., & Kelly, D. F.
Affiliations
  • University of Southern California Keck School of Medicine
  • University of California–Los Angeles David Geffen School of Medicine
  • University of California–Los Angeles School of Medicine
  • Harbor–University of California–Los Angeles (UCLA) Medical Center
  • University of California–San Francisco Schools of Medicine
  • John Wayne Cancer Institute at Saint John's Health Center
Venue
Journal of Neurotrauma
Publisher
SAGE Publications
Published
2010-06
Volume
27
Issue
6
Pages
1007-1019
ISSN
  • 0897-7151
  • 1557-9042
DOI
10.1089/neu.2009.1092
Cited by
69
References
23
Language
en
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)

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