Acute Serum Hormone Levels: Characterization and Prognosis after Severe Traumatic Brain Injury
Open accessAbstract
Experimental traumatic brain injury (TBI) studies report the neuroprotective effects of female sex steroids on multiple mechanisms of injury, with the clinical assumption that women have hormonally mediated neuroprotection because of the endogenous presence of these hormones. Other literature indicates that testosterone may exacerbate injury. Further, stress hormone abnormalities that accompany critical illness may both amplify or blunt sex steroid levels. To better understand the role of sex steroid exposure in mediating TBI, we 1) characterized temporal profiles of serum gonadal and stress hormones in a population with severe TBI during the acute phases of their injury; and 2) used a biological systems approach to evaluate these hormones as biomarkers predicting global outcome. The study population was 117 adults (28 women; 89 men) with severe TBI. Serum samples ( n =536) were collected for 7 days post-TBI for cortisol, progesterone, testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Hormone data were linked with clinical data, including acute care mortality and Glasgow Outcome Scale (GOS) scores at 6 months. Hormone levels after TBI were compared to those in healthy controls ( n =14). Group based trajectory analysis (TRAJ) was used to develop temporal hormone profiles that delineate distinct subpopulations in the cohort. Structural equations models were used to determine inter-relationships between hormones and outcomes within a multivariate model. Compared to controls, acute serum hormone levels were significantly altered after severe TBI. Changes in the post-TBI adrenal response and peripheral aromatization influenced hormone TRAJ profiles and contributed to the abnormalities, including increased estradiol in men and increased testosterone in women. In addition to older age and greater injury severity, increased estradiol and testosterone levels over time were associated with increased mortality and worse global outcome for both men and women. These findings represent a paradigm shift when thinking about the role of sex steroids in neuroprotection clinically after TBI.
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Acute and chronic hypogonadism due to HPA axis dysfunction has been reported in approximately 20-30% of TBI patients.
“Acute and chronic hypogonadism due to HPA axis dysfunction has been reported in approximately 20-30% of TBI patients. 75-78”
From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [78]
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- Authors
- Wagner, A. K., McCullough, E. H., Niyonkuru, C., Ozawa, H., Loucks, T. L., Dobos, J. A., Brett, C. A., Santarsieri, M., Dixon, C. E., Berga, S. L., & Fabio, A.
- Affiliations
- University of Pittsburgh (US)
- Emory University (US)
- Corresponding author
- Wagner, Amy K.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2011-06
- Volume
- 28
- Issue
- 6
- Pages
- 871-888
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- PMC
- PMC3113446
- OpenAlex
- W1983794138
- Cited by
- 172
- References
- 87
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- FWCI
- 6.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neurotrauma (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- National Institutes of Health
- Centers for Disease Control and Prevention (R49CE323155)
- U.S. Public Health Service (R49 CCR323155)
- National Institute of Neurological Disorders and Stroke (P01NS030318)
- Topics
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- traumatic brain injury, sex steroids, testosterone, estradiol, cortisol, progesterone, luteinizing hormone, follicle-stimulating hormone, neuroprotection, biomarkers, prognosis, mortality, Glasgow Outcome Scale, adrenal response, aromatization, sex differences
- MeSH terms
- Acute Disease, Adult, Brain Injuries, Female, Humans, Male, Prognosis, Severity of Illness Index, Gonadal Steroid Hormones, Stress, Physiological, Cohort Studies, Cytoprotection
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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