Changes of pituitary hormones and related factors in patients with prolonged disorders of consciousness

Abstract

Objective To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness (pDOC) and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients. Methods The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. According to the improvement of patients' consciousness, they were divided into consciousness recovery group (n=39) and consciousness non-recovery group (n=48). The secretion levels of pituitary related hormones were measured in the 2 groups, including free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH) and cortisol and prolactin (PRL). According to Coma Recovery Scale-Revised (CSR-R) score, the patients were assigned into vegetative state VS group (n=61) and minimal consciousness state MCS group (n=26). The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed. According to the normal standard of hormone level, the patients were divided into normal hormone level group (n=25) and abnormal hormone level group (n=62). Univariate analysis and logistic regression model were used to explore the influencing factors (age, sex, cause of injury, course of disease, preoperative CRS-R score and injured location, etc.) of pDOC patients. Results Among the 87 pDOC patients, 62 (71.3%) had abnormal pituitary hormones, including 42 cases of single hormone abnormality (67.7%), and 20 cases of more than 2 changes (32.3%). The types and proportions of abnormal pituitary hormones were: GH 18 cases (29.0%), TSH and FT3/FT4 19 cases (30.6%), PRL 11 cases (17.7%), ACTH 8 cases (12.9%), and COR6 cases (9.7%). In the comparison of the differences of pituitary hormone levels between the VS group and MCS group, there were significant differences in GH, TSH, PRL and ACTH between the 2 groups (P < 0.01). Compared with the normal hormone level group, the abnormal hormone level group has an older onset age (P=0.001), a lower proportion of MCS patients (P=0.001), a lower CRS-R score (P < 0.001), a longer ICU stay (P < 0.001), and a higher proportion of paroxysmal sympathetic hyperexcitability syndrome (PSH). Multivariate analysis indicated that age (OR=1.316, P=0.006), CRS-R score (OR=0.200, P=0.037), ICU stay time (OR=3.991, P=0.040) and PSH symptoms (OR=11.874, P=0.040) were major influencing factors for abnormal hormone levels. Conclusion The pDOC patients have a high proportion of abnormal pituitary hormones, which is positively correlated with CRS-R score of patients' consciousness level. ICU stay time and PSH symptoms are risk factors of abnormal pituitary hormones.

Keywords

• disorders of consciousness
• pituitary hormone levels
• disease characteristics
• prognosis
• risk factor