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Hypothalamic dysfunction in acute head-injured patients with stress ulcer
S L Hwang1, A S Lieu, S L Howng
1Division of Neuosurgery, Kaohsiung Medical College Hospital, Taiwan, Republic of China.
The Kaohsiung Journal of Medical Sciences
|October 31, 1998
Summary
Severe head injury can cause pituitary hormone changes and stress ulcers. This study found that stress ulcers in head-injured patients are linked to hypothalamic damage, affecting pituitary hormone levels.
Area of Science:
- Neuroendocrinology
- Trauma Surgery
Background:
- Severe head injury frequently causes hypothalamohypophyseal impairment and hormone abnormalities.
- Stress ulcers are common in head-injured patients, but their link to pituitary hormone alterations is understudied.
Purpose of the Study:
- To investigate pituitary hormone alterations in acute head-injured patients with stress ulcers.
- To evaluate the hypothalamic-pituitary axis function in head-injured patients with and without stress ulcers.
Main Methods:
- Studied 40 male patients with severe head injury (Glasgow Coma Scale 4-10) within 24 hours of injury, excluding shock, sepsis, or prior peptic ulcer disease.
- Assessed stress ulcer presence via endoscopy and measured basal and provocative (TRH and GnRH) serum pituitary hormone levels (TSH, PRL, GH, LH, FSH).
Main Results:
- Stress ulcers were confirmed in 67.5% of patients.
- Patients with stress ulcers showed elevated basal prolactin (PRL) and significantly lower basal thyroid-stimulating hormone (TSH) and growth hormone (GH) levels compared to those without ulcers.
- Provocative testing revealed normal pituitary responses but indicated hypothalamic insufficiency in patients with stress ulcers.
Conclusions:
- Stress ulcers in acute head-injured patients are associated with hypothalamic damage.
- Pituitary hormone abnormalities in these patients suggest hypothalamic dysfunction rather than primary pituitary failure.