To clarify endocrine derangements in patients recovering from traumatic or nontraumatic
brain injury (BI), 40 patients (31 men) having a mean age of 47 ± 17 years were investigated.
BI was due to spontaneous intracerebral hemorrhage (n = 16), trauma (n = 16), ischemic
stroke (n = 7) or ruptured brain aneurysm (n = 1). The median Glasgow Coma Score on
admission in the ICU was 8 and the duration of mechanical ventilation ranged from
2 to 120 days. Patients were enrolled in the study after being transferred in the
rehabilitation unit. Hormonal assessment included the measurement of thyroxine (T4),
tri-iodothyronine (T3), thyrotropin (TSH), cortisol, corticotropin (ACTH), prolactin,
testosterone, estradiol, insulin-like growth factor I (IGF-1), and dehydroepiadrosterone
sulphate (DHEAS). Functional outcome was assessed with the Glasgow Outcome Scale (GOS).
In the entire patient population several endocrine abnormalities were observed, including
low T3 (n = 5), low T4 (n = 5), high TSH (n = 6) or low TSH (n = 1), high cortisol
(n = 4), low ACTH (n = 4) or high ACTH (n = 8), high prolactin (n = 15), low testosterone
(n = 11), low IGF-1 (n = 15), and low DHEAS (n = 10). None of the patients had cortisol
levels below the local reference range for unstressed individuals. The GOS ranged
from 1 to 5 and its distribution was as follows: GOS of 1 (n = 4), GOS of 2 (n = 15),
GOS of 3 (n = 11), GOS of 4 (n = 5), and GOS of 5 (n = 5). There were significant
correlations between GOS and T3 (r = 0.44, P = 0.005), T4 (r = 0.35, P = 0.02), ACTH
(r = 0.43, P = 0.007) and DHEAS (r = 0.34, P = 0.03). In contrast, GOS did not correlate
with TSH, cortisol, prolactin, testosterone, estradiol or IGF-1 levels.
To conclude, endocrine abnormalities are common in patients recovering from acute
traumatic or nontraumatic BI and are related to patients' functional outcome. It remains
to be defined whether such hormonal changes are adaptive or reflect pathology.