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Endocrine response to brain injury

R Chioléro1, M Berger

  • 1Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

New Horizons (Baltimore, Md.)
|November 1, 1994
PubMed
Summary

The neuroendocrine response (NER) to severe brain injury involves complex hormonal changes, impacting patient outcomes. Understanding these endocrine alterations is crucial for defining brain death and guiding potential hormone therapies.

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Area of Science:

  • Neuroendocrinology
  • Trauma Response
  • Critical Care Medicine

Background:

  • The neuroendocrine response (NER) is vital for adapting to trauma, brain injury, and surgery.
  • It involves efferent pathways to the hypothalamic-pituitary-adrenal (HPA) axis and sympathoadrenal system, influencing circulatory and metabolic functions.
  • NER after brain injury is highly variable but generally biphasic, with an initial sympathoadrenal storm.

Purpose of the Study:

  • To explore the neuroendocrine response to brain injury.
  • To investigate the correlation between endocrine changes and patient outcomes.
  • To address unresolved issues regarding cerebral death and hormone replacement therapy in severe brain injury.

Main Methods:

  • Review of existing literature on neuroendocrine responses to trauma and brain injury.
  • Analysis of hormonal changes, including catecholamines and thyroid hormones.
  • Discussion of the role of free radicals and selenium in thyroid metabolism.

Main Results:

  • The NER in brain injury mirrors responses to extracerebral injury but is more variable.
  • A biphasic pattern is observed, with an initial sympathoadrenal storm followed by decreased responses and altered counter-regulatory, gonadal, and thyroid hormones.
  • Patient outcomes correlate with catecholamine levels and the severity of low triiodothyronine syndrome.

Conclusions:

  • Thyroid hormone alterations are linked to reduced peripheral thyroxine deiodination, potentially influenced by free radicals and low selenium levels.
  • Unresolved questions include the precise definition of cerebral death and the utility of hormone replacement therapy in severe brain injury.
  • Further research is needed to clarify the role of endocrine dysfunction in brain injury and its management.

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