Cortisol dynamics, quality of life and fatigue following traumatic brain injury in childhood.

IF 2.6 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM
Nikolaos Daskas, Peta Sharples, Marcus Likeman, Stafford Lightman, Elizabeth Crowne
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引用次数: 0

Abstract

Introduction: Traumatic brain injury (TBI) is a leading cause of acquired neurological morbidity. The prevalence of post-traumatic hypopituitarism (PTHP) and associated morbidity after childhood TBI is unclear. Our study investigated long term HPA (hypothalamus-pituitary-adrenal) axis function, in a prospective childhood TBI and control cohort, using measures of cortisol/cortisone secretion (physiological, stimulated), HPA axis feedback and exploring associations with fatigue, depression and Quality of Life (QoL) outcomes.

Methods: All TBI participants had data concerning severity and mechanism of TBI. All groups had clinical assessment, pituitary/brain MRI, questionnaire measures of QoL, fatigue, depression and salivary cortisone profiles including dexamethasone suppression test. In addition participants with Moderate/Severe TBI had ethical approval for baseline endocrine blood tests, overnight 12-hour venous sampling of cortisol and growth hormone, and stimulated HPA axis evaluation with an insulin tolerance test (ITT).

Results: Seventy-two participants with moderate/severe (n=31, age 19.8±4.2 years) or mild TBI (n=24, age 17.8±5.1 years) and matched controls (n=17, age 18.5±5.5 years) took part. Time post TBI was 6.8-10.8 years. Baseline endocrine tests confirmed normal thyroid and posterior pituitary function. One female with moderate/severe TBI had hypogonadism. Pituitary neuroimaging was normal in all participants. In 2/25 ITT and 9/22 overnight serum profiles peak cortisol was <500nmol/l. The two participants with suboptimal ITT cortisol response (392 and 483nmol/L) also had low peak spontaneous serum levels (227 and 447nmol/L respectively). Salivary cortisone profiles showed preservation of HPA axis circadian rhythm and suppression with dexamethasone in all but one TBI participant. TBI participants had higher morning salivary cortisone levels compared to controls. Fatigue was reported by 20/46 TBI participants but only 1/14 controls. Fatigue was not associated with stimulated (ITT) or spontaneous (overnight profile) cortisol, however one TBI participant with severe fatigue had a suboptimal ITT cortisol response. Specific QoL attributes of health state (cognition, memory) were impaired in TBI participants compared to controls.

Conclusion: Although not as prevalent as previously reported, HPA axis dysfunction does occur in survivors of childhood TBI confirming the need for endocrine surveillance. However, in most of our paediatric TBI survivors assessed 7-11 years post-TBI, HPA function and circadian rhythmicity was preserved or had recovered. Chronic fatigue is a common concern post TBI but in the majority not associated with frank HPA axis dysfunction. Morning salivary cortisone levels were higher in TBI survivors, (who have a high prevalence of fatigue) compared to healthy controls, despite the recognised association of chronic fatigue with cortisol hyposecretion.

儿童脑外伤后的皮质醇动态、生活质量和疲劳。
导言:创伤性脑损伤(TBI)是后天性神经系统发病的主要原因。创伤后垂体功能减退症(PTHP)的发病率以及儿童创伤性脑损伤后的相关发病率尚不清楚。我们的研究通过测量皮质醇/可的松分泌量(生理性、刺激性)、HPA轴反馈,并探讨与疲劳、抑郁和生活质量(QoL)结果的关联,对前瞻性儿童创伤性脑损伤和对照队列中的长期HPA(下丘脑-垂体-肾上腺)轴功能进行了调查:方法:所有创伤性脑损伤参与者都有创伤性脑损伤严重程度和机制的相关数据。所有组别都进行了临床评估、垂体/脑核磁共振成像、生活质量、疲劳、抑郁和唾液可的松概况(包括地塞米松抑制试验)的问卷调查。此外,患有中度/重度创伤性脑损伤的参试者还需进行伦理批准的基线内分泌血液检测、皮质醇和生长激素的12小时静脉采样,以及通过胰岛素耐受性试验(ITT)对HPA轴进行刺激评估:72名中度/重度(31人,年龄为(19.8±4.2)岁)或轻度创伤性脑损伤(24人,年龄为(17.8±5.1)岁)患者和匹配对照组(17人,年龄为(18.5±5.5)岁)参加了此次研究。创伤后时间为 6.8-10.8 年。基线内分泌检查证实甲状腺和垂体后叶功能正常。一名患有中度/重度创伤性脑损伤的女性患有性腺功能减退症。所有参与者的垂体神经影像学检查结果均正常。在 2/25 例 ITT 和 9/22 例隔夜血清分析中,皮质醇峰值均为结论值:尽管不像以前报道的那样普遍,但儿童创伤性脑损伤幸存者中确实存在 HPA 轴功能障碍,这证实了对内分泌进行监测的必要性。然而,在我们评估的大多数儿童创伤性脑损伤幸存者中,创伤后 7-11 年的 HPA 功能和昼夜节律性得以保留或恢复。慢性疲劳是创伤性脑损伤后的常见问题,但大多数人的慢性疲劳与HPA轴功能障碍无关。尽管慢性疲劳与皮质醇分泌过少有关,但与健康对照组相比,创伤性脑损伤幸存者(疲劳发生率高)早晨唾液中的可的松水平更高。
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来源期刊
Hormone Research in Paediatrics
Hormone Research in Paediatrics ENDOCRINOLOGY & METABOLISM-PEDIATRICS
CiteScore
4.90
自引率
6.20%
发文量
88
审稿时长
4-8 weeks
期刊介绍: The mission of ''Hormone Research in Paediatrics'' is to improve the care of children with endocrine disorders by promoting basic and clinical knowledge. The journal facilitates the dissemination of information through original papers, mini reviews, clinical guidelines and papers on novel insights from clinical practice. Periodic editorials from outstanding paediatric endocrinologists address the main published novelties by critically reviewing the major strengths and weaknesses of the studies.
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