In the critically ill patient with neurologic injury (SAH, TBI), the initial treatment focus is to maintain adequate cerebral perfusion pressure, control intracranial pressure, and limit secondary injury.
Once stabilized, however, it is important to consider endocrine dysfunction in the brain injured patient.
Endocrine dysfunction is common in neurologic injury and may lead to increased morbidity and mortality. In fact, over half of SAH patients develop acute dysfunction of the HPA, resulting in low growth hormone, ACTH, and TSH.
In addition to hormonal dysfunction, sodium abnormalities (i.e. hyponatremia) are present in up to 80% of critically ill SAH patients.
Consider hormonal replacement therapy (or hypertonic saline in cases of severe hyponatremia) for patients with evidence of endocrine dysfunction. For some, this therapy can be life-saving.
Vespa PM. Hormonal dysfunction in neurocritical patients. Curr Opin Crit Care 2013; 19:107-12.