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      Endocrine changes in patients recovering from acute traumatic or nontraumatic brain injury: pattern and correlations with functional outcome

      abstract
      1 , 2 , 2 , 2 , 2 , 2 , 2 , 1
      Critical Care
      BioMed Central
      24th International Symposium on Intensive Care and Emergency Medicine
      30 March - 2 April 2004

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          Abstract

          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.

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          Author and article information

          Conference
          Crit Care
          Crit Care
          Critical Care
          BioMed Central
          1364-8535
          1466-609X
          2004
          15 March 2004
          : 8
          : Suppl 1
          : P247
          Affiliations
          [1 ]Attikon Hospital, Athens, Greece
          [2 ]Evangelismos Hospital, Athens, Greece
          Article
          cc2714
          10.1186/cc2714
          4099834
          065bddaf-78fe-43fa-a218-99d5b106b825
          24th International Symposium on Intensive Care and Emergency Medicine
          Brussels, Belgium
          30 March - 2 April 2004
          History
          Categories
          Poster Presentation

          Emergency medicine & Trauma
          Emergency medicine & Trauma

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