1/23. Inappropriate secretion of antidiuretic hormone after cerebral injury.A case has been presented in which a patient sustained a closed head injury with concomitant maxillofacial injuries; early signs of water intoxication and ISADH developed six days after injury. This disorder was corrected by restricting free water intake for six days until equilibration occurred. Successful reduction of the facial fractures was accomplished after stabilization of the patient's neurological condition and correction of her metabolic disorder. The ISADH and resulting hyponatremia have been documented in a variety of disease states including trauma to the central nervous system. Disruption or irritation to the hypothalamic-neurohypophyseal system has been proposed as the mechanism of dysfunction after cerebral injury. The results of the secretion of inappropriate amounts of ADH relative to renal function and homeostatis have been discussed. Clinical and laboratory diagnosis as well as the elective and emergency management of ISADH have been reviewed. The fact that the sequelae of this abnormal metabolic state may mimic or mask the neurological deterioration which may follow cerebral injury is significant. This may contribute to the difficulty in making a correct diagnosis and designing proper therapy. The problem is basically one of differentiating a correctable metabolic disorder from a lesion that can be fatal unless surgically removed.- - - - - - - - - - ranking = 1keywords = antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
2/23. Acute symptomatic hyponatremia and cerebral salt wasting after head injury: an important clinical entity.hyponatremia is a well known complication of traumatic and nontraumatic cerebral injury, often related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Nonetheless, it also can be associated with a different entity, the syndrome of cerebral salt wasting (CSW). The authors report the case of a 4.5-year-old boy presenting with major head injury who at day 6 after admission had generalized tonic-clonic seizures caused by severe acute hyponatremia (serum sodium level, 119 mmol/L) and signs of dehydration. Despite initial isotonic rehydration, hyponatremia persisted because of excessive renal salt losses and concomitant enormous water losses, necessitating increasing amounts of sodium, up to 160 mmol/kg/d, and large amounts of intravenous fluids, up to 27 L/d. Highly increased levels of atrial natriuretic peptide (ANP) confirmed the diagnosis of CSW. The occurrence of a CSW has to be recognized early in the clinical course for adequate treatment and remains one of the important differential diagnosis of SIADH in hyponatremic states in patients with cerebral disorders, especially after head injury.- - - - - - - - - - ranking = 0.24869874276667keywords = antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
3/23. Reversible myocardial dysfunction after traumatic brain injury: mechanisms and implications for heart transplantation.Reversible myocardial dysfunction is known to occur in patients with cerebrovascular accidents and brain death. Several mechanisms for transient myocardial dysfunction have been proposed, including increased sympathetic activity, hormone depletion, and a reduction in coronary perfusion pressure. The relative importance of each of these mechanisms remains controversial. We report the case of a 19-year-old man who suffered traumatic brain death associated with reversible myocardial dysfunction despite elevated cardiac enzymes. Myocardial recovery occurred after correcting his hemodynamic instability and hypothermia emphasizing the importance of normalization of coronary perfusion pressure and core body temperature. The mechanisms for reversible myocardial dysfunction and their implications for heart transplantation following traumatic brain death are reviewed. A diagnostic strategy is proposed that would allow early recognition of reversible myocardial dysfunction in brain-dead patients.- - - - - - - - - - ranking = 0.002004782610406keywords = hormone (Clic here for more details about this article) |
4/23. Spontaneous recovery from posttraumatic hypopituitarism.hypopituitarism is an increasingly recognized complication of traumatic brain injury that can have significant potential to impair recovery and rehabilitation in affected survivors. Although posttraumatic cranial diabetes insipidus is known to be transient in many cases, recovery of established anterior pituitary hormone deficiency is thought to be a very rare event. We report the case of a 25-yr-old man who incurred severe traumatic brain injury in 1997. Sixteen months later, dynamic pituitary stimulation tests revealed severe growth hormone and adrenocorticotropin hormone deficiency. He was treated with recombinant human growth hormone and hydrocortisone. Five years after traumatic brain injury, repeat neuroendocrine assessment, prompted by an increasing serum insulin-like growth factor-1 level, showed normal growth hormone and adrenocorticotropin hormone responses. This is the first case report, to our knowledge, to show that adult posttraumatic growth hormone deficiency can be reversible. The recognition that anterior pituitary dysfunction can recover after traumatic brain injury has implications for the follow-up of patients with hypopituitarism secondary to head trauma to avoid unnecessary, expensive, and potentially harmful therapy.- - - - - - - - - - ranking = 0.014033478272842keywords = hormone (Clic here for more details about this article) |
5/23. Behavioral treatment of adipsia in a child with hypothalamic injury.Damage to the hypothalamic region is known to affect a wide range of homeostatic and adaptive functions, including water and food regulation, temperature control, hormone secretion and behavior. Deficient thirst is a serious consequence of hypothalamic injury, since water losses are not replaced by drinking. The effectiveness of behavioral procedures in increasing drinking is described for a child with diminished thirst secondary to hypothalamic injury.- - - - - - - - - - ranking = 0.0072098115437139keywords = secretion, hormone (Clic here for more details about this article) |
6/23. Delay in diagnosis of hypopituitarism after traumatic head injury: a case report and review of the literature.Neuroendocrine complications are among important and frequently missed complications of traumatic brain injury. hypopituitarism, the partial or complete insufficiency of anterior pituitary secretion may be underrecognized due to its subtle clinical manifestations in traumatic patients. We report a case of 14.5-year-old girl who was admitted due to growth failure and had been diagnosed to have multiple hypophyseal hormone deficiency including thyroid-stimulating hormone, gonadotropins, adrenocorticotropin hormone which developed years after traumatic head injury.- - - - - - - - - - ranking = 0.011219376764526keywords = secretion, hormone (Clic here for more details about this article) |
7/23. Neuropsychiatric disturbances and hypopituitarism after traumatic brain injury in an elderly man.Neuropsychiatric or cognitive disturbances are common complications after traumatic brain injury. They are commonly regarded as irreversible sequelae of organic brain injuries. We report a case of hypopituitarism in a 77-year-old man who presented with long-term neuropsychiatric disturbances, including cognitive impairment, disturbed sleep patterns, personality change, loss of affect, and visual and auditory hallucinations after a traumatic subdural hemorrhage. The treatment response to hormone replacement therapy was nearly complete. hypopituitarism is rarely considered in patients who sustain traumatic brain injury and the neuropsychiatric manifestations of posttraumatic hypopituitarism have rarely been reported. This case highlights the importance of hypopituitarism as a potential reversible cause of neuropsychiatric disturbances after traumatic brain injury.- - - - - - - - - - ranking = 0.002004782610406keywords = hormone (Clic here for more details about this article) |
8/23. Panhypopituitarism after traumatic head injury.INTRODUCTION: We describe a case report of panhypopituitarism after traumatic head injury. A previously healthy young man suffered a closed head injury and multiple spinal fractures after a motorcycle accident. methods: His treatment in the intensive care unit was prolonged because of numerous problems with raised intracranial pressure, hemodynamics, and electrolyte balance. RESULTS: Eventually, hypocortisolism and other pituitary hormone deficiencies were diagnosed. Magnetic resonance images showed incoherent pituitary stalk and re-review of the first computed tomography scans of the day of the accident confirmed hemorrhage in the infundibulum. CONCLUSION: This case and review of the literature suggests that hormone deficiencies are not uncommon after head injuries.- - - - - - - - - - ranking = 0.004009565220812keywords = hormone (Clic here for more details about this article) |
9/23. Transient MR changes and symptomatic epilepsy following gamma knife treatment of a residual GH-secreting pituitary adenoma in the cavernous sinus.OBJECTIVE: To report a rare side effect of gamma knife treatment of pituitary macroadenoma. CASE REPORT: In a forty-one-year old female patient acromegaly was diagnosed due to a growth hormone secreting pituitary macroadenoma. Following transsphenoidal surgery the patient underwent gamma knife treatment for persistent uncontrolled acromegaly activity of residual tumor, infiltrating the left cavernous sinus. 15 months later, complex partial seizures were diagnosed and 17 months after gamma knife treatment a gadolinium enhancing lesion was detected in her left medial temporal lobe. radiation induced changes, radiation necrosis or a glioma were considered. Neuropsychological testing indicated potentially significant post-surgical deficits. Therefore, surgical action was postponed and anti-epileptic treatment was started. Four months later she was free of seizures and an MR scan showed an almost complete regression of the gadolinium enhancing lesion, indicating that it had been due to radiation induced changes. CONCLUSION: Gamma knife surgery of a pituitary adenoma may cause radiation induced MR changes of the mesial temporal lobe mimicking glioma or radionecrosis and cause symptomatic epileptic seizures. The awareness of this rare complication is important to avoid unnecessary and potentially harmful diagnostic or therapeutic interventions.- - - - - - - - - - ranking = 0.002004782610406keywords = hormone (Clic here for more details about this article) |
10/23. Precocious puberty in children after traumatic brain injury.True precocious puberty frequently occurs secondary to central nervous system pathology and is a rare sequelae of severe head injury in early childhood. It is a clinical entity consisting of accelerated somatic development, thelarche and pubarche. We describe two female children, 3 and 5 years of age, who, following head trauma, displayed early pubertal changes including breast enlargement, pubic hair and vaginal secretions. Subsequent laboratory tests, which included hormone assays and luteinizing hormone response after injection of luteinizing hormone releasing hormone, established the diagnosis of precocious puberty of central origin. Long-term sequelae of this condition include accelerated skeletal growth and advanced bone age eventually resulting in short stature. The most effective form of treatment is long-acting luteinizing-hormone-releasing-hormone agonists, which result in temporary reversible chemical castration.- - - - - - - - - - ranking = 0.017233724595744keywords = secretion, hormone (Clic here for more details about this article) |
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