Hypothalamic Dysfunction in Acute Head-Injured Patients with Stress Ulcer

頭部外傷有壓力性潰瘍患者可能合併下視丘損傷

黃旭霖(Shiuh-Lin Hwang) ； 劉安祥(Ann-Shung Lieu) ； 洪純隆(Shen-Long Howng) ； 謝建勳(Jan-Sung Hsieh) ； 黃宗人(Tsung-Jen Huang)

《The Kaohsiung Journal of Medical Sciences》 14卷9期 (1998/09) Pp. 554-560

https://doi.org/10.6452/KJMS.199809.0554

摘要

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gondotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p＜0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p＜0.001). In the patients with stress ulcer, significant increases (p＜0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely haedinjured patients. In patients with sturess ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.

並列摘要

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gondotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p＜0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p＜0.001). In the patients with stress ulcer, significant increases (p＜0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely haedinjured patients. In patients with sturess ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.

並列關鍵字

head injury ； stress ulcer ； hypothalamus