ABSTRACT
Objective To investigate changes of relative pituitary hormones in adults with traumatic brain injury (TBI) and the related clinical significance.Methods Quantitative analysis and dynamic observation of relative pituitary hormones were performed in 158 TBI patients by electrochemical luminescence method.Measured indices included plasma total cortisol (PTC),free triiodothyronine (lT3),free thyroxine (FT4),thyrotropin (TSH),growth hormone,follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol,testosterone,and prolactin.Results Prolactin and PTC increased in the acute phase,but gradually reduced three days after trauma.TSH,FT3,and FT4 slightly decreased after trauma,followed by a gradual return.While there were no significant changes in FSH,LH,estradiol,testosterone,and growth hormone after trauma.Changes in relative pituitary hormones were more profound in patients with a lower GCS.Some patients presented different degree of reduced hormones in recovery period and needed hormone replacement therapy.Among the patients with poor activity of daily living (ADL),lvothyroxine replacement therapy was applied in 2 patients (2/6),prednisone acetate in 1 (1/6),and eleven acid testosterone in 2 (2/6).Among patients with mild ADL,levothyroxine replacement therapy was applied in 2 patients (11％),prednisone acetate in 1 (6％),and eleven acid testosterone in 3 (17％).Among patients with good ADL,levothyroxine replacement therapy was applied in 2 patients (4％) and eleven acid testosterone in 3 (6％).Persistent prolactin elevation was found in patients with poor outcome.Conclusions Changes of relative pituitary hormones in adult patients with TBI are associated with severity and duration of trauma.Abnormal prolactin level can affect outcome of the patients.
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Objective To explore the dynamic changes and clinical significance of relative pituitary hormones in children after craniocerebral injury.Methods The quantitative analysis and dynamic observation were performed in 125 children after craniocerebral injury and 20 voluntary healthy children of relative pituitary hormones including serum prolactin(PRL),cortisol(PTC),three free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),growth hormone (GH) by applying electrochemical luminescence method.Tbe hormone variational characteristics were analyzed according to posttraumatic time,Glasgow Coma Scale(GCS) scores on admission and Glasgow Outcome Scale (GOS) scores on discharge,and the relationship between hormone variational characteristics of 58 cases was followed up over 2 years and the activities of daily living (ADL) were also investigated.Results The serum PRL was significantly increased on the first,third and fifth day compared with the healthy control group (P =0.000 0,0.000 0,0.006 7),respectively.There was significant difference between mild,moderate and severe groups within 30 days after suffering from craniocerebral injury (P ＜ 0.05).PTC was heavily increased within 3 days,and significant difference existed among mild and moderate groups mild and severe groups (all P ＜ 0.05) ; TSH,FT3,FT4 decreased slightly after injury and gradually rose in later;GH change wasn't significant;and the larger variation of relative pituitary hormones was responsible for lower GCS scores;FT3,FT4,TSH,and GH decreased in different degrees,which were found in parts of children with craniocerebral injury,and the significant difference of serum PRL existed between GOS scores 4-5 and GOS scores 1-3 groups (P =0.000 1).Conclusions The changes of relative pituitary hormones were associated with the posttraumatic time and the severity of craniocerebral injury.The PRL in serum can aid in prediction of outcome for the children with craniocerebral injury.
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Objective To investigate the localization and surgical outcome of epileptogenic nidus of post-traumatic epilepsy. Methods A retrospective analysis was performed on clinical data of 62 patients with post-traumatic epilepsy treated microsurgicallly from November 2005 to May 2009. There were 48 males and 14 females, at age range from 11 to 48 years old (average 28.8 years old). The epileptogenic nidus in 59 patients was localized based on clinical manifestations, visual electroencephalography (V-EEC) imaging and electrophysiological findings and that in three patients localized by implanted intracranial electrodes. Under electrocorticogram (ECoG) monitoring, we resected cerebral malacia in 36 patients, removed both malacia and epileptogenic nidus in 15, and partially resected cerebral malacia combined with cortex thermocoagulation in 11. Results The follow-up for 6-33 months showed that there were 32 patients at grade Ⅰ , 17 at grade Ⅱ , nine at grade Ⅲ and four at grade Ⅳ according to Engel classification system. Conclusion V-EEG is an important method for pre-operative localization of epileptogenic nidus of post-traumatic epilepsy. Microsurgical management can attain favorable outcome under ECoG monitoring.