Full Access
Changes of sympatho-adrenal and hypothalamo-pituitary-adrenocortical system in patients with head injury
L Kôiv,
E. Merisalu, K. Zilmer, T. Tomberg, A.-E. Kaasik,
Corresponding Author
L Kôiv
Departments of Neurology and Neurosurgery
Dr Leho Kôiv, Department of Neurology and Neurosurgery, University of Tartu, 2 L. Puusepp St, EE 2400 Tartu, EstoniaSearch for more papers by this authorL Kôiv,
E. Merisalu, K. Zilmer, T. Tomberg, A.-E. Kaasik,
Corresponding Author
L Kôiv
Departments of Neurology and Neurosurgery
Dr Leho Kôiv, Department of Neurology and Neurosurgery, University of Tartu, 2 L. Puusepp St, EE 2400 Tartu, EstoniaSearch for more papers by this authorAbstract
To determine the role of the sympatho-adrenal (SAS) and hypothalamo-pituitary-adrenocortical system (HPAS) after head injury, the relationship between venous blood epinephrine (E), norepinephrine (NE), adrenocorticotropic hormone (ACTH), Cortisol levels, and clinical condition was examined in 55 patients. These observations suggest that head injury causes mainly activation of the above-mentioned systems depending on the severity of trauma. An inverse correlation between the levels of E, NE and Glasgow Coma Scale score, indicating the severity of head injury was revealed. ACTH and Cortisol were similarly related to the clinical condition, although the observed correlation was less expressed. The changes in hormonal levels were present during the whole research period (1 week), although a certain shift to normalization was observed. However, catecholamines and ACTH levels in plasma were relatively low in severely head-injured patients whose CT scans revealed serious alterations in the mesencephalic-diencephalic area. At the same time their Cortisol levels obtained maximal values and their chance to survive was diminutive. The results of this study indicate that investigation of hormones of SAS and HPAS might be useful as an additional method in the complex of ordinary examinations in establishing early prognosis in patients with brain injury.
References
- 1 Pitts LH, McIntosh TK. Dynamic changes after brain trauma. In: R Braakman, ed. Handbook of clinical neurology. Vol. 13: Head injury. Amsterdam : Elsevier, 1990: 65–100.
- 2 Sblye H. The stress of life. New York : McGraw-Hill, 1956.
- 3 Kaufman HH, Timberlake G, Voelker J, Pait TG. Medical complications of head injury. Med Clin North Am 1993: 77: 43–60.
- 4 Silver JM. Sandberg DP, Hales RE. New approaches in the pharmacotherapy of posttraumatic stress disorder. J Clin Psychiatry 1990: 51 (suppl): 33–8.
- 5
Dunn AJ.
Stress, neurochemistry of. In: JA Hobson, ed.
Abnormal states of brain and mind.
Boston
: Birkhauser, 1989: 108–10.
10.1007/978-1-4899-6768-8_48 Google Scholar
- 6 King LR, McLaurin RL, Lewis HP, Knowles HC. Plasma Cortisol levels after head injury Ann Surg 1970: 172: 975–84.
- 7 Woolf PD, Lee: LA, Hamill RW, McDonald JV. Thyroid test abnormalities in traumatic brain injury: correlation with neurologic impairment and sympathetic nervous system activation. Am J Med 1988: 84: 201–8.
- 8 R Dolecek, L Brizio-Molteni, A Moltkni, D Traber, eds. Endocrinology of thermal trauma: pathophysiologic mechanisms and clinical interpretation. Philadelphia , London : Lea & Febiger, 1990.
- 9 Rosner MJ, Newsome HH, Becker DP. Mechanical brain injury: the sympathoadrenal response. J Neurosurg 1984: 61: 76–86.
- 10 Woolf PD. Hamill RW, Lee LA, Cox C, McDonald JV. The predictive value of catecholamines in assessing outcome in traumatic brain injury. J Neurosurg 1987: 66: 875–82.
- 11 Woolf PD, Hamill RW, Lee LA. McDonald JV. Free and total catecholamines in critical illness. Am J Physiol 1988: 254: 287–91.
- 12 Pfenniger E. Adrenalin- und Noradrenalinausschuttung unmittelbar nach einem akuten Schadel-Hirn-Trauma sowie daraus resultierende metabolische Veranderungen. Anaesthesiol Reanim 1991: 16: 243–9.
- 13 Pail AJ. Evaluation of concentrations of free plasma adrenaline and noradrenaline and these connected with protein. Lab Delo 1979: 5: 297–301.
- 14 Slatisticas for Windows operating system. Tulsa , Okla : StatSoft Inc, 1994.
- 15 Chiolero R. Lemarchand T, Schutz Y et al. Plasma pituitary hormone levels in severe trauma with and without head injury. J Trauma 1988: 28: 1368–74.
- 16 Chiolero R, Schutz Y, Lemarchand T et al. Hormonal and metabolic changes following severe head injury or noncranial injury. J Parenter Enteral Nutr 1989: 13: 5–12.
- 17 Ott L. Young B. McClain C. The metabolic response to brain injury. J Parenter Enteral Nutr 1987: 11: 488–93.
- 18 Damianova G. Vantov M, Titianova E. Adrenohypophy-seal hormones and catecholamines in patients with diencephalic pathology. Neurol Psychiatr (Bucur) 1989: 27: 127–31.
- 19 Ratge D, Knoll E, Diener U, Hadjidimos A, Wisser H. Orcadian rhythm of catecholamines, Cortisol and prolactin is altered in patients with apallic syndrome in comparison with normal volunteers. Acta Endocrinol (Copenh) 1982: 101: 428–35.
- 20 Shibaia M, Einhaus S, Schweitzer JB, Zuckerman S, Leffler CW. Cerebral blood flow decreased by adrenergic stimulation of cerebral vessels in anaesthetized newborn pigs with traumatic brain injury. J Neurosurg 1993: 79: 696–704.
- 21 van Loon J, Shivalkar B, Plets C, Goffin J, Tjandra-Maga TB, Flameng W. Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg 1993: 79: 705–9.
- 22 Hamill RW, Woolf PD, McDonald JV, Lee LA, Kelly M. Catecholamines predict outcome in traumatic brain injury. Ann Neurol 1987: 21: 438–43.
- 23 Pentelenyi T. Significance of endocrine studies in general assessment and general prediction of fatal outcome in head injury. Acta Neurochir Suppl (Wien) 1992: 55: 21–4.
- 24 Koide T, Wieloch TW, Siesjö Bo K. Circulating catecholamines modulate ischemic brain damage. J Cereb Blood Flow Metab 1986: 6: 559–65.
- 25 Wurtman RJ, Zervas NT. Monoamine neurotransmitters and pathophysiology of stroke and central nervous system trauma. J Neurosurg 1974: 40: 34–6.
- 26 Harruff RC. Subendocardial hemorrhages in forensic pathology autopsies. Am J Forensic Med Pathol 1993: 14: 284–8.
- 27 Colgan FJ, Sawa T, Teneyck LG, Izzo JL. Protective effects of 6-blockade on pulmonary function when intracranial pressure is elevated. Crit Care Med 1983: 11: 368–72.
- 28 Payen D, Quintin L, Plaisance P, Chiron B, Lhoste F. Head injury: Clonidine decreases plasma catecholamines. Crit Care Med 1990: 18: 392–5.
- 29 Hansson L. Review of the state-of-the-art beta-blocker therapy. Am J Cardiol 1991: 67: 43B–6B.
- 30 Shenkin HA, Gutterman P, Bouzarth WF. The adrenocortical response to craniotomy for brain tumor. J Neurosurg 1971: 34: 657–64.
- 31 Arita K, Uozumi T, Oki S, Kurisu K, Ohtani M, Mikami T. The function of the hypothalamo-pituitary axis in brain of dead patients. Acta Neurochir (Wien) 1993: 123: 64–75.
- 32 Shapira Y, Davidson E, Weidenfeld Y, Cotev S, Shohami E. Dexamethasone and indomethacin do not affect brain edema following head injury in rats. J Cereb Blood Flow Metab 1988: 8: 395–402.
- 33 Toutant S, Klauber M, Marshall L et al. Absent or compressed basal systems of first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 1984: 61: 691–4.
- 34 Lindvall O, Auer RN, Siesjo Bo K. Mechanisms of hypoglycemic brain damage. Evidence against a significant role of the noradrenergic locus coeruleus system. Exp Brain Res 1988: 73: 219–23.
- 35 Takahashi H, Sato H, Tsuii Y. Biochemical markers in the acute stage of head injury-aldosterone and CK-BB. Neurol Med Chir (Tokyo) 1989: 29: 192–5.
- 36 Ross DA, Olsen WL, Ross AM, Andrews BT, Pitts LH. Brain shift, level of consciousness, and restoration of consciousness in patients with acute intracranial hematoma. J Neurosurg 1989: 71: 498–502.
- 37 Jenkins A, Teasdale G, Hadley MD, Macpherson P, Rowan JO. Brain lesions detected by magnetic resonance imaging in mild and severe head injuries. Lancet 1986: 2: 445–6.
- 38 Snow RB, Zimmerman RD, Gandy SE et al. Comparison of magnetic resonance imaging and computed tomography in the evaluation of head injury. Neurosurgery 1986: 18: 45–52.
- 39 Crompton MR. Hypothalamic lesions following closed head injury. Brain 1971: 94: 165–72.
- 40 Feldman Z, Contant CF, Pahwa R et al. The relationship between hormonal mediators and systemic hypermetabolism after severe head injury. J Trauma 1993: 34: 806–16.
- 41 Hadfield JM, Little RA, Jones RA. Measured energy expenditure and plasma substrate and hormonal changes after severe head injury. Injury 1992: 23: 177–82.
