Hormonal profiles in patients with isolated brain trauma, polytrauma, and combined brain and polytrauma

Abstract

Hormonal changes after trauma and in states of critical illness have been described, however it is still not clear if these changes represent an unspecific reaction to injury or develop specific patterns dependent of injury type. Moreover, a large proportion of patients after traumatic brain injury (TBI) develop persisting hypopituitarism and it remains to be determined if predictors of posttraumatic hypoptiuitarism can be seen in the acute posttraumatic phase. We have measured hormonal levels in 21 patients (5 females) with isolated head trauma (group 1), combined head and polytrauma (group 2) and polytrauma without head trauma (group 3, 7 patients in each group). Measurements were done upon arrival at the emergency room, every 6 hours until day 3, daily until day 10, on day 14, 21 and day 28. We measured ACTH, cortisol, GH, IGF-1, LH, FSH, testosterone, estradiol, prolactin, FT3, FT4, and TSH. ACTH increased until 9 hours, then decreased steeply to unmeasurable levels in many patients. Cortisol was initially elevated in groups 2 and 3 and decreased to partially subnormal levels in all groups after day 10. A dissociation of GH and IGF-1 was found in the first 3 days with high GH and low IGF-1 (most pronounced in group 1) and subsequent normalisation in the following days. In males estradiol levels were partially elevated and testosterone levels decreased in the first four days, indicating an activation of aromatase. After initial elevation, prolactin quickly decreased to normal or low levels. FT3 was often decreased with FT4 and TSH being mainly in the normal range. These results show that hormone levels after trauma display a strongly dynamic pattern. The injury pattern seems to have an influence on specific hormonal profiles. Previous studies have shown dynamic and injury-specific changes of cytokines after trauma which may as well mutually interact with endocrine changes.