Traumatic Brain Injury: Research Study on Endocrinological Aspects

Project location: ITALY, Pisa
Project start date: January 2011 - Project end date: December 2012
Project number: 2010-81
Beneficiary: Department of Endocrinology and Metabolism University of Pisa

PROJECT TITLE:    Traumatic Brain Injury: research study of the endocrinological aspects
Over the recent years, it has been paid particular attention to the possible endocrine abnormalities in patients with previous history of brain injury. It is unknown which is the contribution of post-traumatic hypopituitarism effects on physical and neuropsychiatric morbidity in traumatic patients.
The first study about post-traumatic hypopituitarism was described more than 50 years ago with a prevalence of 0.7%. Since then, studies available in the literature report a prevalence from 20 to 80%, with partial or total hypopituitarism.
Considering the high prevalence of head injuries, their clinical and social impact, and possible neuroendocrinological complications, in this population it was necessary investigate the presence of any hormonal deficiency, even after several years from traumatic event.
This project assess the prevalence of hypopituitarism in patients with previous head injury, and particularly studied the frequency of pituitary deficiency ,isolated or in combination. Moreover, the idea that these patients may take advantage from hormone replacement therapy, showing a marked clinical improvement after this treatment, the project’s team  submitted these patients to a careful follow-up to verify the stability or possible changes in biochemical, instrumental and cognitive parameters.
From June 2011 to December 2012 ,the team evaluated 50 patients with previous head injury of different degrees according to the Glasgow coma scale and at different time of injury: 3 months-20 years.
All patients were assessed using the criteria of the research project previously presented, in particular, have been made:
•  medical history and physical examination; opening of a computerized medical record ad hoc by the researchers involved in the research project in order to verify the enrollment in the study group;
• Baseline blood chemistry samples: blood count, blood glucose, electrolytes, creatinine, uric acid, transaminase, gamma-GT, LDH, CK, examination of the urine);
• Lipid and glucose assessment: total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood glucose, glycated hemoglobin;
• Evaluation of water balance, plasma and urinary osmolality;
• baseline hormonal evaluation: FT4, FT3, TSH, cortisol, ACTH, FSH, LH, estradiol / testosterone, PRL, GH and IGF-I;
• evaluation of pituitary function with dynamic test with:
•GHRH + arginine injection e.v. of 1 μg/kg of GHRH at time 0 'followed by the infusion in 30' of 0.5 g / kg of L-arginine hydrochloride with blood samples for GH every 15 'to 90' for the Evaluation of the GH-IGF-I was carried out in 40 of 50 patients (80%), 1 patient (2%) had a previous diagnosis of GH deficiency treated with GH replacement therapy
•TRH injection e.v. of 200 μg Antepan with blood samples for TSH 0'-15'-30'-45'-60'-90'-120 'to assess the pituitary-thyroid function was performed in 31 of 50 patients (62%) 5 patients were already treated with L-thyroxine at the time of evaluation for a chronic autoimmune thyroiditis.
•Synacten test: i.m. Injection of 250 μg tetracosactide esacetato with determination of cortisol at 0'-30'-60 'for cortisol performed in 20/50 patients 40%;
•CRH injection e.v.  with determination of ACTH and cortisol was performed in 16/50   patients (32%);
•a combination of both tests (CRH and Synacten was carried out in 4/50 patients (8%).
•Test of thirst for the presence of a central diabetes insipidus was performed in 3 of 50 patients (6%), 1 patient had a previous diagnosis of insipidus central diabetes.
65% of patients examined at the first clinical control were tested after 6 months and 31% after 12 months.
This project was carried out with the collaboration of neurologists, neuroradiologists and neurological rehabilitation staff of the University Hospital of Pisa.
The clinical and scientific data obtained are constantly updated in a computerized database and definitive results required a period of work for at least one year.

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