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Hypothalamic-pituitary function in patients with prolonged coma.

J Sack, L Sazbon, B Lunenfeld

    The Journal of Clinical Endocrinology and Metabolism
    |March 1, 1983
    PubMed
    Summary
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    Patients in prolonged coma show variable hypothalamic-pituitary function, preserving diurnal cortisol and thyroid axis regulation. However, human growth hormone (hGH) secretion may be abnormally affected by stimuli.

    Area of Science:

    • Neuroendocrinology
    • Critical Care Medicine
    • Hormone Physiology

    Background:

    • Prolonged coma, often resulting from traumatic brain injury or cardiac arrest, presents significant challenges in managing patients.
    • Understanding the hypothalamic-pituitary axis function is crucial for assessing recovery and guiding therapeutic interventions in these patients.

    Purpose of the Study:

    • To evaluate the diurnal variation of cortisol secretion in patients with prolonged coma.
    • To assess the pituitary hormone secretion (human growth hormone [hGH], prolactin [PRL], thyroid-stimulating hormone [TSH]) and their responses to stimulation tests (TRH, L-dopa).
    • To characterize the hypothalamic-pituitary function in patients experiencing extended periods of unconsciousness.

    Main Methods:

    • Studied eight patients (six male, two female) hospitalized for prolonged coma (164-1320 days).

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  • Assessed diurnal cortisol variation, basal serum levels of T4, cortisol, hGH, hPRL, and hTSH.
  • Administered TRH and L-dopa stimulation tests to evaluate pituitary hormone release (hGH, PRL, TSH).

    • Main Results:

    • Basal serum levels of T4, cortisol, hGH, hPRL, and hTSH were within normal ranges.
    • Cortisol diurnal variation was preserved in six of eight patients.
    • Normal responses to TRH were observed for hPRL and hTSH in seven patients; hGH secretion showed variable responses to TRH and L-dopa, with some patients exhibiting significant increases and others no response.

    Conclusions:

    • Patients with prolonged coma exhibit variable hypothalamic-pituitary function.
    • The cortisol diurnal rhythm and the hypothalamic-pituitary-thyroid axis, along with prolactin secretion, are generally preserved.
    • Human growth hormone (hGH) secretion capacity can be impaired, showing abnormal responses to various stimuli in prolonged coma.