Methylprednisolone exacerbates acute critical illness-related corticosteroid insufficiency associated with traumatic brain injury in rats.

Emerging evidence demonstrates that severe illness could induce critical illness-related corticosteroid insufficiency (CIRCI) and cause poor prognosis. The purpose of this study was to test the hypothesis that methylprednisolone (MP), a synthetic glucocorticoid, promotes post-traumatic apoptosis in both the hypothalamus and pituitary, resulting in acute CIRCI and increased mortality in the acute phase of traumatic brain injury (TBI). We tested this hypothesis by measuring acute CIRCI in rats subjected to fluid percussion injury (FPI) and treated with MP (5-30mg/kg).

Spontaneous recovery from isolated post-traumatic central hypogonadism in a woman.

Objective: Hypopituitarism is a recognized complication of Traumatic Brain Injury (TBI). Resolution of established anterior pituitary hormones deficiency is rare.

Case Report: A woman was initially presented at the age of 22 years with amenorrhoea.

Transarterial embolization of traumatic carotid-superior hypophyseal arterial cavernous fistula. A case report.

A 26-year-old man presented with symptoms of progressive bilateral exophthalmos and swelling of the eyelids after a severe head injury. Angiography confirmed a direct carotid-superior hypophyseal arterial (SHA) cavernous fistula with petrosal sinus and intracavernous sinus drainage. Successful transarterial coil embolization of the fistula was performed with resolution of the patient's symptoms.

Fatigue after traumatic brain injury: Association with neuroendocrine, sleep, depression and other factors.

Objective: Define associations between post-traumatic brain injury (TBI) fatigue and abnormalities in neuroendocrine axes, sleep, mood, cognition and physical functioning.

Design: Survey.

Setting: Large community hospital-based rehabilitation centre.

[First manic episode in the elderly--consider a subdural haematoma due to head trauma as cause].

A manic episode in old age presents a diagnostic challenge to the clinician due to the different symptomatology often difficult to distinguish from delirium, dementia, agitated depression and psychosis. To complicate matters further, a first episode of mania in later life is very often based on underlying physical and cerebral pathology ('secondary mania'). Many causes of 'secondary mania', including neurological, systemic or endocrine diseases, infections, intoxications, apnoea, post-thoracic surgery and vitamin B12 deficiency have been described to date, but there have been no reports on subdural haematomas in this context.

Salivary biosensors for screening trauma-related psychopathology.

After facial trauma, a distinct subset of patients goes on to develop mental health problems including recalcitrant psychopathology. Early identification of maladaptive stress reactions provides opportunities for initiating preemptive mental health interventions and hinges on the surgeon's ability to differentiate between transient distress and precursors of recalcitrant psychiatric sequelae. The comprehensive care of injured patients will benefit greatly from objective adjuncts and decision-making tools to complement the clinical evaluation.

[Late evaluation of the pituitary-gonadal axis in survivors of severe traumatic brain injury].

Objective: The purpose of this study is to evaluate pituitary function impairment in order to verify the prevalence of sex hormone deficiency and to analyze the profile of TBI population.

Methods: Thirty patients were studied, 22 were male and 8 were female. All patients had their gonadal function assessed and they were evaluated at a median of 4 years post-trauma.

Hypogonadism after traumatic brain injury.

Traumatic brain injury (TBI) is the most common cause of death and disability in young adults. Post-TBI neuroendocrine disorders have been increasingly acknowledged in recent years due to their potential contribution to morbidity and, probably, to mortality after trauma. Marked alterations of the hypothalamic-pituitary axis during the post-TBI acute and chronic phases have been reported.

Delayed diagnosis of hypopituitarism following severe traumatic brain injury.

The following case illustrates a 10-year delay in the diagnosis of hypopituitarism after severe traumatic brain injury in a 22-year-old man crushed by a forklift truck. His symptoms of mood changes, headaches and sleep pattern disturbances were attributed to post traumatic brain injury syndrome resulting in a delay in diagnosing the underlying pathology. Following recurrent episodes of symptomatic hyponatraemia, hypopituitarism was diagnosed.

Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms.

Background: Voice and swallowing symptoms are frequently reported early after thyroidectomy even in the absence of laryngeal nerves injury. We evaluated the short-term and long-term outcomes of these functional alterations.

Methods: Consenting patients undergoing total thyroidectomy (TT) were enrolled.

Permanent central diabetes insipidus after mild traumatic brain injury.

Aim: The patients in the permanent diabetes insipidus (DI) group are more likely to have more severe TBI, which is defined by a post-resuscitational and pre-sedational Glasgow Coma Scale (GCS) score of 8/15 or less. This study presents a case of permanent, central DI following mild traumatic brain injury with post-resuscitation GCS 13/15.

Case Report: A 17-year-old boy suffered from mild brain injury and experienced permanent DI without any anatomical changes on image in the early stage of traumatic brain injury.

Early stress response: a vulnerability framework for functional impairment following mild traumatic brain injury.

Nearly 64% of people with mild traumatic brain injury (MTBI) experience prolonged symptoms and functional impairments lasting months or years postinjury. Explanations for delayed recovery have varied and lacked a guiding framework, hindering intervention science. Using theory substruction and adapting McLean and associates' biopsychosocial model for chronic pain after trauma, we suggest that perceived psychological stress and associated neurobiological responses may predict risk for functional impairment.

Traumatic brain injury causes long-term reduction in serum growth hormone and persistent astrocytosis in the cortico-hypothalamo-pituitary axis of adult male rats.

Unlabelled: In humans, traumatic brain injury (TBI) causes pathological changes in the hypothalamus (HT) and the pituitary. One consequence of TBI is hypopituitarism, with deficiency of single or multiple hormones of the anterior pituitary (AP), including growth hormone (GH). At present no animal model of TBI with ensuing hypopituitarism has been demonstrated.

Surgical complications after endoscopic transsphenoidal pituitary surgery.

Between January 2004 and June 2007 we conducted a retrospective analysis to assess post-operative complications related to endoscopic pituitary surgery in a series of 150 patients. Patients were treated with an endoscopic endonasal transsphenoidal approach to the sellar region for removal of pathological sellar and suprasellar lesions. We analysed the complications in groups according to the anatomical structures of the approach and the functional systems of the pituitary gland (anterior and posterior endocrine systems), and compared them to a large historical series using the traditional microsurgical transsphenoidal approach.

Neuroendocrine disorders after traumatic brain injury.

Traumatic brain injury (TBI) is the most common cause of death and disability in young adults living in industrialised countries, in which 180-250 persons per 100 000 per year die or are hospitalised as a result. Neuroendocrine derangements after TBI have received increasing recognition in recent years because of their potential contribution to morbidity, and possibly mortality, after trauma. Marked changes of the hypothalamo-pituitary axis have been documented in the acute phase of TBI, with as many as 80% of patients showing evidence of gonadotropin deficiency, 18% of growth hormone deficiency, 16% of corticotrophin deficiency and 40% of patients demonstrating vasopressin abnormalities leading to diabetes insipidus or the syndrome of inappropriate anti-diuresis.

Does the type and severity of brain injury predict hypothalamo-pituitary dysfunction? Does post-traumatic hypopituitarism predict worse outcome?

Several studies have reported a close association between traumatic brain injury (TBI) and pituitary dysfunction, and expert panels have recently proposed recommendations for hormone assessment and replacement for pituitary insufficiency after TBI. Given the high incidence of TBI, identification of reliable predictors is of utmost importance in order to secure a cost-effective screening strategy. It has not yet been possible to identify early hormone alterations as a useful tool for the prediction of long-term post-traumatic hypopituitarism, whereas indicators of increased trauma severity have been reported as predictive in an increasing number of studies.

Adrenal insufficiency following traumatic brain injury in adults.

Purpose Of Review: Hypoadrenalism occurs in approximately 25% of patients soon after traumatic brain injury. Neurosurgeons or critical care physicians should be prepared to diagnose and treat this and other related hormonal deficiencies.

Recent Findings: The severity of traumatic brain injury, location of basilar skull fractures and edema or hemorrhage within the hypothalamic-pituitary axis appear correlated with secondary adrenal failure.

Endocrine sequelae of traumatic brain injury in childhood.

Background: Anterior pituitary hormone dysfunction may be an important feature of long-term morbidity in survivors of traumatic brain injury (TBI). The hypothalamic-pituitary structures are vulnerable to damage following head injury. Therefore, pituitary dysfunction, which may be detected months or years after injury, is now well recognised as a long-term consequence of TBI in adults.

Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury.

Objective: The objective was to study the anatomical changes in the pituitary gland following acute moderate or severe traumatic brain injury (TBI).

Design: Retrospective, observational, case-control study.

Setting: Neurosciences Critical Care Unit of a university hospital.

Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study.

Objective: To assess the prevalence of hypopituitarism following traumatic brain injury (TBI), describe the time-course and assess the association with trauma-related parameters and early post-traumatic hormone alterations.

Design: A 12-month prospective study.

Patients: Forty-six consecutive patients with TBI (mild: N = 22; moderate: N = 9; severe: N = 15).

Predictors of anterior pituitary insufficiency after traumatic brain injury.

Background: Several studies have reported a high prevalence of hypopituitarism after traumatic brain injury (TBI). Risk stratification is a prerequisite for cost-effective hormonal screening of these patients. However, it is still unclear which risk factors predispose patients to develop anterior hypopituitarism after TBI.

Histologic study of the human pituitary gland in acute traumatic brain injury.

Purpose: Approximately 25% of patients with traumatic brain injury (TBI) may develop partial or complete hypopituitarism. The causative mechanisms involved in its development are not clear. To the authors' knowledge, there have been no recent morphologic studies of the pituitary following TBI.

Fatigue after TBI: association with neuroendocrine abnormalities.

Objective: Evaluate the association between neuroendocrine findings and fatigue after traumatic brain injury (TBI) Research design: Prospective, observational.

Methods And Procedures: Sixty-four individuals at least 1 year post-TBI underwent neuroendocrine testing including thyroid, adrenal, gonadal axes and growth hormone (GH) after glucagon stimulation with assessment of fatigue using the Global Fatigue Index (GFI) and the Fatigue Severity Scale (FSS).

Main Outcomes And Results: GFI and FSS scores were significantly higher within this sample compared to published control data.

Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective.

In survivors of traumatic brain injury (TBI), impairment in anterior pituitary hormone function may be an important cause of long-term morbidity. Histopathological evidence from post-mortem studies suggests that the hypothalamic-pituitary structures are vulnerable to damage following head injury. Pituitary dysfunction, present months or years after injury, is now well recognised in adults, however, little evidence is known about this potential complication in children and adolescents.

Algorithm for safe and effective reoperative thyroid bed surgery for recurrent/persistent papillary thyroid carcinoma.

Background: The aim of this study was to review our experience with reoperative thyroid bed surgery (RTBS) for recurrent/persistent papillary thyroid cancer (PTC), and present an algorithm for safe and effective RTBS.

Methods: This is a retrospective study. Records of 33 consecutive patients who underwent RTBS for recurrent/persistent PTC in a previously operated thyroid bed, and were operated upon by the senior author (R.