The Change Of The Anterior Pituitary Hormone And The Clinical Significance In The Severe Traumatic Brain Injury

Background: Traumatic brain injury (TBI) has already became the serious problem threaten public health. In recent studies, the change of Anterior pituitary hormone is not rare after TBI, the pituitary function abnormality may exacerbate existing impairments of physical, cognitive caused by TBI, if Anterior pituitary hormone abnormality can be diagnosed timely and the rules of dynamic change can be found, we can evaluate the outcome more properly and improved the outcome.Objective: By measure the levels of the GH, TSH, FSH, LH and PRL on the patients suffered sTBI in different times after hospitalized. To stude the rule of the dynamic changes and to investigate the relationship between pituitary function abnormality and the outcome. So we can know more about the clinical diagnosis and the hormone substitution therapy to improve the outcome.Methods: From January, 2006 to December, 2006, 48 cases of the hospitalized patients with acute sTBI were enrolled to be traumatic group and measured the levels of the GH, TSH, FSH, LH and PRL on 1st, 7th, 14th, 21st days after hospitalized . meanwhile, 20 normal control persons were sellected and measured the same hormones. Clinical outcomes were valued by using the Glasgow Outcome Scale score(GOSs) at 3 months after injury.Results: (1) The incidences of abnormality about FSH and LH can reach as high as to 52.1% and 45.8%. (2) On 1st day, Statistics significance (P < 0.05) can be observed when we compare TSH in ssTBI group and sTBI group to normal control group. On 1st, 7th, 14th, 21st days after hospitalized, Statistics significance (P < 0.05) can be observed when we compare FSH and LH levels in ssTBI group and sTBI group to normal control group. There is no statistics significance between ssTBI group and sTBI group. (3) On 1st day after hospitalized, the TSH level in poor outcome group was significantly higher than the one in the favorable outcome group, but on 7th, 14th, 21st days, the level was significantly lower. On 1st, 7th, 14th, 21st days, the FSH and LH levels in poor outcome group was significantly lower than the levels in the favorable outcome group. On 1st day, the GH and PRL levels in poor outcome group was significantly higher than the levels in the favorable outcome group.Conclusion: (1) The change of FSH and LH is the most common with the patients after sTBI. (2) The Anterior pituitary hormone may significantly change after TBI. On the 1st day, TSH level in ssTBI group and sTBI group is higher than the normal control group. On 1st, 7th, 14th, 21st days, FSH and LH levels in ssTBI group and sTBI group lower than the normal control group. When condition of the patients became better, the pituitary function seem can be improved gradually. But there is no significant relationship between the change of the hormones and severity. (3) The change of the change of the anterior pituitary hormone can be use to predicating the outcome of the sTBI. The hormone level of the patients in poor outcome group will significantly change on 1st day after injure or decrease fiercely in follow days. On the contrary, the patient whose hormone level change slightly or can be greatly improved will have favorable outcome.