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Related Experiment Videos

Hypothalamic hypothyroidism and hypogonadism in prolonged traumatic coma.

A S Fleischer, D R Rudman, N S Payne

    Journal of Neurosurgery
    |November 1, 1978
    PubMed
    Summary

    Prolonged traumatic coma depletes cerebrospinal fluid cyclic adenosine monophosphate (cAMP), leading to pituitary-hypothalamic dysfunction. This study found consistent hypothyroidism and hypogonadism in patients with severe head injuries.

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    Area of Science:

    • Neuroendocrinology
    • Neurology
    • Endocrinology

    Background:

    • Prolonged coma post-head trauma correlates with reduced cerebrospinal fluid (CSF) cyclic adenosine monophosphate (cAMP).
    • Previous research implicated cAMP in neuroendocrine secretion, suggesting a potential link to pituitary-hypothalamic function disruption.

    Purpose of the Study:

    • To investigate pituitary-hypothalamic function in adult male patients with traumatic coma exceeding two weeks.
    • To assess the relationship between CSF cAMP levels and specific pituitary hormone deficiencies.

    Main Methods:

    • Measured ventricular CSF cAMP and plasma hormone levels (TSH, T4, free T4, T3, LH, FSH, testosterone) in 15 male patients with prolonged traumatic coma.
    • Monitored hormone levels at regular intervals and correlated them with coma severity and CSF cAMP depletion.

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  • Administered thyrotrophic-releasing hormone and gonadotrophic-releasing hormone to assess pituitary response.

    • Main Results:

    • All patients exhibited subnormal CSF cAMP and plasma levels of TSH, thyroid hormones, LH, FSH, and testosterone.
    • Reductions in plasma thyroxine and testosterone were proportional to coma severity and CSF cAMP depletion.
    • Hormonal deficiencies improved in patients who regained consciousness, while persistent deficits were observed in deeply comatose patients.

    Conclusions:

    • Traumatic coma lasting over two weeks is regularly associated with suprahypophyseal hypothyroidism and hypogonadism.
    • The observed endocrine dysfunction appears to originate from a deficiency above the pituitary gland.
    • CSF cAMP levels may serve as an indicator of the severity of neuroendocrine disruption following head trauma.