Cited by 47Traumatic Brain Injury ResearchHormonal and reproductive studiesTraumatic Brain Injury and Neurovascular Disturbances

Persistent hypogonadism influences estradiol synthesis, cognition and outcome in males after severe TBI

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Wagner, Amy K., Brett, Christopher A., McCullough, Emily H., Niyonkuru, Christian, Loucks, Tammy L., Dixon, C. Edward, Ricker, Joseph, Arenth, Patricia +1 more·2012·Brain Injury

Abstract

OBJECTIVE: Acute hypogonadotropic hypogonadism (AHH) occurs frequently after TBI, as does chronic hypogonadotropic hypogonadism. However, AHH and persistent hypogonadotropic hypogonadism (PHH) after TBI are not well studied. The objective of this study was to characterize longitudinal hormone profiles and the impact of AHH and PHH on outcome. METHODS: In this prospective cohort study, men with severe TBI (n = 38) had serum gonadal and gonadotropic hormones measured during weeks 1-52 post-injury. AHH, PHH and/or early resolving hypogonadotropic hypogonadism (ERHH) were based on temporal hormone assessments. PHH and hormone profiles were then compared to multiple outcome measures 6-12 months post-TBI. RESULTS: AHH affected 100% of the population, while 37% subsequently developed PHH. Acute testosterone (TEST) and estradiol/testosterone (E2/TEST) ratios were associated with PHH and outcome. Over time, post-acute TEST and E2 levels for the ERHH group approached normal range, while levels for the PHH group remained low. Post-acute gonadotrophin levels were within the normal range for both groups. PHH, along with lower post-acute TEST and E2 profiles, was associated with worse functional and cognitive outcomes at 6 and 12 months post-injury. CONCLUSIONS: These results support screening for post-acute secondary hypogonadism and further research to assess the mechanisms underlying PHH and associated functional and cognitive deficits.

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Crossref · 10.3109/02699052.2012.667594

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  • Chronic pituitary dysfunction is reported in 15-60% of adults after TBI.

    “with reports of chronic pituitary dysfunction in 15-60% of adults after TBI [1-5]”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [2]

    The Introduction reports chronic hypopituitarism after TBI, but gives a prevalence range of 1.4–29%, not 15–60%. The paper therefore supports the general occurrence of chronic pituitary dysfunction, but states a contrary numerical range. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • In the acute period after TBI, there is no clear role for evaluating anterior pituitary axes other than the ACTH-cortisol axis because changes are thought to serve a compensatory purpose and may be temporary.

    “there is no clear role for evaluating the other anterior pituitary axes (thyroid, sex hormone, and growth hormone) as changes are thought to serve a compensatory purpose and may be temporary[1, 2].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [2]

    The Introduction says the acute stress response after severe TBI produces HPG-axis deficits, and the Discussion says those deficits resolve for some patients. The paper does not say that the changes serve a compensatory purpose or that there is no clear role for evaluating the thyroid, sex-hormone, and growth-hormone axes in the acute period; its Discussion instead recommends a thorough work-up before hormone replacement. Page numbers are unavailable in our copy. (LLM, conf=0.82)

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Research works printed but not linked: 5

  1. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480-484.
  2. van Veelen NM, Grootens KP, Peuskens J, Sabbe BG, Salden ME, Verkes RJ, Kahn RS, Sitskoorn MM. Short term neurocognitive effects of treatment with ziprasidone and olanzapine in recent onset schizophrenia. Schizophrenia Research 2010;120(1-3):191-198.
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  5. Garringer J, Wagner AK. Impact of aromatase genetic variation on hormone levels and functional outcome after TBI. American Journal of Physical Medicine and Rehabilitation 2010;89(Suppl):S6.

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Authors
Wagner, A. K., Brett, C. A., McCullough, E. H., Niyonkuru, C., Loucks, T. L., Dixon, C. E., Ricker, J., Arenth, P., & Berga, S. L.
Affiliations
  • University of Pittsburgh (US)
  • Emory University (US)
Corresponding author
Wagner, Amy K.
Venue
Brain Injury
Published
2012-05-09
Volume
26
Issue
10
Pages
1226-1242
ISSN
  • 0269-9052 (ISSN-L)
  • 1362-301X
OpenAlex
W1996125219
Cited by
47
References
105
Citations by year
2026: 1 · 2025: 5 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 2 · 2016: 5 · 2015: 7 · 2014: 5 · 2013: 3 · 2012: 2
FWCI
4.07
Type
journal article
Language
en
Open access
Locations
  • Brain Injury (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
  • National Institutes of Health
  • Centers for Disease Control and Prevention
  • U.S. Public Health Service (R49 CCR323155)
  • National Institute of Neurological Disorders and Stroke (P01NS030318)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Keywords
severe traumatic brain injury, estradiol, testosterone, testosterone/estradiol ratio, gonadotropins, cognitive outcomes, functional outcome
MeSH terms
Adolescent, Adult, Aged, Brain Injuries, Cognition, Cognition Disorders, Estradiol, Humans, Hypogonadism, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Stress, Physiological, Glasgow Outcome Scale, Young Adult

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