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This is an Educational PowerPoint on Endocrine Dysfunction with Traumatic Brain Inury Patients.
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Neuroendocrine Dysfunction Following Traumatic Brain Injury
Anne Louise Houle-Gregory RN, BSNClinical Educator Trauma and Emergency Services
Regional One Health
Objectives
Relate where the hypothalamus is located and the role it play in controlling visceral, autonomic, endocrine and emotional functions.
Describe pituitary gland as “Master Gland”. Discuss mechanisms of injury to the hypothalamus and pituitary. Recognize clinical features and endocrine disturbances. Define ACTH (HPA Axis). Define TSH (Pituitary Thyroid Axis). Differentiate between disease entities. Restate clinical precursors. List and explain the components of admission endocrine panel. Discuss the Glucagon Stimulation Test (GST) Protocol
introduced in 2013. Examine suggested protocol Evaluation
HypothalamusLocation and Function
Location Function Responsible for
Brain Made Simple, n.d.
Pituitary Gland
“Master Gland” Hypothalamus link Anatomy Hormones
› Anterior Lobe› Posterior Lobe
The Washington Endocrine Clnic, 2014
Mechanisms of Injury to the Hypothalamus and Pituitary Hypoxic insult Hemorrhage
(compression) Edema Increased intracranial
pressure Vascular injury Direct mechanical
injury › Hypothalamus› Pituitary stalk› Pituitary gland Life Extensions (2012)
Clinical Features and Endocrine Disturbances Endocrine Disorders
› Diabetes insipidus› Anterior
hypopituitarism› Syndrome of
inappropriate antidiuretic hormone
› Cerebral salt washing
› Primary adrenal insufficiency
Polyuria
Polydipsia
Nocturia
Headache
↓ AppetiteFatigue
Low Blood PressureHyponatremia
Cognitive Slowing
Ataxia
Anorexai
↓Serum OsmolarityCerebral
EdemaSeizures
Coma
Weakness
Skin pigmentation
Abdominal pain
ACTH (HPA Axis)
CRF↓
CRF and CRF Receptors↓
ACTH Released↓
Receptors of Adrenal Cortex↓
Cortisol Release
University of Virginia (2014)
TSH (Pituitary Thyroid Access
Thyroid stimulating hormone
Pituitary thyroid access.
(University of Virginia 2014)
FSH-LH (Pituitary Gondal Axis)
FSH› Males› Females
LH› Males› Females
Pituitary Gonadal Axis
Geeky Medics (2011)
Disease Processes
Growth Hormone› Deficiency› Excess
Diabetes Insipidus (ID)
Syndrome of Inappropriate Antidiruetic Hormone (SIADH)
Cerebral Salt Wasting (Significance, 2013)
Clinical Precursors
Elevated ICP Prolonged
Hypotension Subarachnoid
Hemorrhage Ischemia Hypoxia
(Significance, 2013)
Admission Endocrine Panel
Primary› Growth Hormone› Lutenizing
Hormone› Thyroid Stimulating
Hormone (TSH)› Adrenocorticotropic
Hormone (ACTH)› Follicle-Stimulating
Hormone, acts at ovaries and testes (FSH)
Secondary› IGF-1
(Insulin-like growth factor-1)
› Testosterone/Estrogens› T3 and T4
(Thyroid Hormones)› Cortisol
Glucagon Stimulation Test (GST) Protocol
Assessment of pituitary-adrenal axis (GH and ACTH/cortisol).
Contraindications to testing
Principle of test Side Effects Preparation Supplies Interpretation Sensitivity and Specificity
Blood Draws
0 Minutes take 2 mL blood into plain tube for cortisol & GHimmediately give Glucagon intra-muscularly.
150 Minutes take 2 mL blood into plain tube for cortisol & GH
180 Minutes take 2 mL blood into plain tube for cortisol & GH
Questions?
ReferencesAcerni, C., & Tasker, R. (2008). Neuroedocrine consequences of traumatic brain injury. Journal of Pediatric Endocrinology Metabolism, 21(7), 611-619.
Alschuler, L. (2014). The HPA axis & stress response. Retrieved from http://www.integrativepro.com/Resources/Integrative-Blog/2014/February/The-HPA-Axis
Behan, L., Phillips, J., & Thompson, C. (2008). Neuroendocrine disorders after traumatic brain injury. Journal of Neurology/Neurosurgery/Psychiatry, 79(7), 753-759.
Berkely University. (n.d.). FSH and LH. Retrieved from https://mcb.berkeley.edu/courses/mcb135e/fsh-lh.htmlBrain Made Simple. (n.d.). Hypothalamus. Retrieved from http://brainmadesimple.com/hypothalamus.html
Biochemical Investigations in Laboratory Medicine. (2013). Glucagon test of the hypothalamo-pituitary axis. Retrieved from http://www.pathology.leedsth.nhs.uk/dnn_bilm/Investigationprotocols/Pituitaryprotocols/GlucagonTestforPituitaryFunction.aspx
DeSanctis, V., Sprocati, M., & Govoni, M. (2008). Assessment of traumatic brain injury and anterior pituitary dysfunction in adolescents. Georgia Medical News, 18-23.
Douborg, D., & Messerer, M. (2011). Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction. Retrieved from http://www.medscape.com/viewarticle/753229_5
Garimella-Krovi, S., & Kemp, S. (2012). Cerebral salt-wasting syndrome clinical presentation. Retrieved from http://emedicine.medscape.com/article/919609-clinical
Geeky Medics. (2013). How the Gonadal Axis Works - Geeky Medics. Retrieved from http://geekymedics.com/2011/02/27/how-the-gonadal-axis-works/
HealthLine. (2012). Growth Hormone Deficiency: Causes, Symptoms & Diagnosis. Retrieved from http://www.healthline.com/health/growth-hormone-deficiency#Overview1
References
Khardori, R. (2014). Diabetes insipidus clinical presentation. Retrieved from http://emedicine.medscape.com/article/117648-clinical
Kaulfers, A., Backejauw, P., Reifschneider, K., Blum, S., Machaud, L., & Weiss, M. (2010). Endocrine dysfunction following traumatic brain injury in children. Journal of Pediatric Endocrinol Metabolism, 157(6), 891-899.
Klauer, K., & Khardori, R. (2014). Adrenal crisis in emergency medicine clinical presentation. Retrieved from http://emedicine.medscape.com/article/765753-clinical
Klein, M., Potter, P., Talavera, F., Kolaski, K., Allen, K., & Lorenzo, C. (2012). Post head injury endocrine complications clinical presentation. Retrieved from http://emedicine.medscape.com/article/326123-clinical
Life Extension. (2012). Using Hormones to Heal Traumatic Brain Injuries. Retrieved from http://www.lef.org/magazine/mag2012/jan2012_Using-Hormones-Heal-Traumatic-Brain-Injuries_01.htm
Life Extension. (2012). Using Hormones to Heal Traumatic Brain Injuries - 2 - Life Extension. Retrieved from http://www.lef.org/magazine/mag2012/jan2012_Using-Hormones-Heal-Traumatic-Brain-Injuries_02.htmLohani, S., & Devkota, U. (2011). Hyponatremia in patients with traumatic brain injury: Etilogy, incidence, and servity correlation. World Neurosurgery, 76(3-4), 355-360. Medscape. (2012). Cerebral salt-wasting syndrome clinical presentation. Retrieved from http://emedicine.medscape.com/article/919609-clinical
Mesquite, J., Varela, A., & Medina, J. (2010). Trauma and the endocrine system. Endocrinal Nutrition, 57(10), 492-9. Momi, J., Tang, C., Abcar, A., Kujubu, D., & Sim, J. (2010). Hyponatremia- what is cerebral salt wasting? The Permenente Journal, 14(2), 62-65.
NY Times Health Information. (2013). Hypopituitarism - Symptoms, Diagnosis, Treatment of Hypopituitarism. Retrieved from http://www.nytimes.com/health/guides/disease/hypopituitarism/overview.html
Powner, D., & Boccalandro, C. (2008). Adrenal insufficiency following traumatic brain injury in adults. Current Opinion Care, 14(2), 163-166.
ReferencesThomas, C., & Bautman, V. (2014). Syndrome of inappropriate antidiuretic hormone secretion clinical presentation. Retrieved from http://emedicine.medscape.com/article/246650-clinical
University of Virginia. (2014). Hypothalamic/pituitary axis: Adrenals and thyroid. Retrieved from http://faculty.virginia.edu/rastinejad/hypo.pdf
The Washington Endocrine Clnic. (2014). Pituitary-Care. Retrieved from http://www.washingtonendocrineclinic.com/Pituitary-Care.html
Wikepedia. (2013). Growth hormone - Wikipedia, the free encyclopedia. Retrieved from http://en.wikipedia.org/wiki/Growth_hormone
Wikepedia. (2014). Hypothalamic–pituitary–thyroid axis. Retrieved June 30, 2014, from http://en.wikipedia.org/wiki/Hypothalamic%E2%80%93pituitary%E2%80%93thyroid_axis
Yang, Y., Lin, J., Hsia, S., Wu, C., Wang, H., & Hung, P. (2011). Central diabetes insipudus in children with acute brain insult. Pediatric Neurology, 45(6), 377-380.