Background and Goal of the Study:
When Central Neural System is damaged various disruption of interconnectivity within hypothalamus as well as between other parts of the brain and internal organs can develop. In this work we want to study hormonal failures comatose state patients in neurosurgical intensive care.
Methods and Materials:
We studied 15 patients (9 men and 6 women) age 18 to 65. 5 had a heavy cranial trauma, 3 had brain tumors operated, 7 had a brain vascular pathologies. All patients were receiving neurovegetative stabilization treatment (NVS) for 3 – 7 days, utilizing fentonyl, clopheline and thiopental sodium. Dexason was administered to 10 patients as an anti-oedema therapy. After awakening the level on consciousness was 5–8 on GCS. During the study we monitored BP, pulse, temperature, diuresis, protein, albumin, creatine kinase, ALT, blood and urine electrolytes, ACTH, TSH, cortisol, prolactin, natiuretic peptide, FT3 and FT4.
All patients demonstrated the lower level of TSH during NVS treatment. 7 patients. developed central hyperthermia. TSH normalization happened during 2–3 days after stopping administering thiopental sodium. 10 patients developed sympathetic storming of various degrees, which required the continuation of NVS therapy. 4 patients remaining in coma for more than 2 weeks had a lower level of FT3. The level of ACTH and cortisol was normal for all the patients not receiving Dexason. FT4 level was normal for all observations. 8 patients developed transitory diabetes insipidus, 6 – cerebral salt-wasting syndrome. All patients exhibited a noticeably increased level of natriuretic peptide.
The most frequent endocrine disruptions for comatose state patients in neurosurgical intensive care are sympathetic storming and disruption of thermoregulation. They often develop water-electrolyte disruption. Despite the heavy brain damage we could not detect any severe damage to Hypothalamic-Pituitary-Adrenal Axis or Hipothalamic-Pituitary-Thyroid Axis.
Intensive care. National Guidebook. Moscow, Goetar-Media 2009. pp. 377–396
© 2012 European Society of Anaesthesiology