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DANIEL RUDMAN, ALAN S. FLEISCHER, MICHAEL H. KUTNER, JOHN F. RAGGIO, Suprahypophyseal Hypogonadism and Hypothyroidism During Prolonged Coma After Head Trauma, The Journal of Clinical Endocrinology & Metabolism, Volume 45, Issue 4, 1 October 1977, Pages 747–754, https://doi.org/10.1210/jcem-45-4-747
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Abstract
Prolonged coma after head trauma is associated with a depletion of 3′,5′ cyclic adenosine monophosphate (cAMP) in the cerebrospinal fluid (CSF). Because cAMP has been implicated in neuroendocrine secretion, we have examined pituitary-hypothalamic function in 7 adult male patients with traumatic coma lasting longer than 2 weeks. Within 1–3 days after trauma, a ventricular catheter connected to a subcutaneous Rickham reservoir was placed in the lateral ventricle to treat intracranial hypertension. Via the reservoir, CSF cAMP was measured at 2–4 day intervals for 10–25 days. Simultaneously, plasma hormone concentrations were also determined.
CSF cAMP and plasma levels of TSH, T4, free T4, T3, LH, FSH, and testosterone became subnormal in all 7 cases. In 5 patients whose level of consciousness fluctuated, the reductions in plasma T4 and testosterone were proportional to both severity of coma (r > 0.89, P < .01) and depletion of CSF cAMP (r > 0.81, P < .05). In 3 patients who remained deeply comatose for 17–25 days, the hypothyroidism and hypogonadism persisted. In 3 cases who regained consciousness, both endocrine defects improved partially or completely.
Injection of 1) TRH and 2) GnRH elicited normal or supernormal increases in plasma concentrations of 1) TSH, and 2) LH and FSH.
An additional 4 men were studied who remained in deep coma for more than 1 month after craniocerebral trauma. Twenty-nine to 32 days after onset of coma, plasma TSH, T4, free T4, T3, and testosterone were all subnormal.
These observations show suprahypophyseal hypothyroidism and hypogonadism occur regularly in patients with coma lasting longer than 2 weeks after head trauma.
