J.Jpn. Surg. Soc.. 56(4): 467-478, 1955

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ENDOCRINOLOGICAL ASPECT ON POSTTRAUMATIC ENCEPHALOPATHY

It is generally accepted that the endocrinological disturbance is rather a rare occurrence after the head injury. However, our observations made on more than 500 cases of posttraumatic encephalopathy suggest that this is not true and the this disturbances caused by endocrinological dysharmony after head trauma are seen more frequently than it has been believed, i.e., that the cases which show no clinical syndromes of known endocrinological diseases have also dysfunction of endocrinological type.
Typical endocrinological syndromes seen among our series of head trauma are as follows.
1) Simmond's Syndrome (2 cases, one male and one female No injury of skull roentgenologially verified. Symptoms appear evident in both cases during the period of 2 years after the head trauma. Typical metabolic disturbances with the decreased body weight, hypotension, concentrated blood, dehydration and lowered libido. Symptoms improved with the administration of anterior pituitary, adrenal cortex and gonadotropic hormones.
2) Dystrophia adiposogenitalis on a female, and eunuchoidism on a case of male patient. In the latter, trauma before the age of the puberty and the gradual onset of signs of eunuchoidism.
3) Diabetes insipidus (two cases of male patients) In the first case bone fissure seen about the sella turcica. Polyuria amounting 60~30 litres a day seen immediately after the trauma. No pathological finding seen in the skull in the second case. Urine output 15 litres a day. No improvement seen after the anterior pituitary implantation.
4) Addison's Syndromes on eight male patients. Syndromes appear gradually during the periods of 1 1/2-2 years after the trauma. Typical metabolic disturbances with the hypotension of blood pressure, decreased body weight, dehydration and pigmentation Gradual imporvement seen in both cases with the administration of anterior pituitary and adrenal cortex hromones.
5) Metropathia haemorrhagica. Three cases. On one case improvement demonstrated after pneumoencephalography. In 2 cases improvement obtained with the hormone treatment.
Besides these cases of endocrinological disorders mentioned above the authors examine on many cases of post-traumatic encephalopathy from the endocrinological stand point, and find that disorders of endocrinological origin are seen not infrequently in spite of the lack of typical symptoms.
The data obtained from these cases will be summarized as follows.
a) Blood pressure. The tendency to hypotension. (systolic blood pressure under 110 mm Hg, 98 among 142 cases)
b) Blood sugar level. Lowering of insulin tolerance
c) Circulating plasma volume (PV/W). Lowered PV/W value found not infrequently Seasonable fluctuation of this value (automnal oligemia)
d) Extracellular fluid volume moderately reduced.
e) ACTH-Test, 17-Ketosteroid in urine (See Tab. 8, case 1, 3, 4, 6, 7, 10, ＆ 13.)
After these extensive endocrinological study, the authors come to the conclusion that these endocrinological disturbances caused by head injury, also originated from the damage on the diencephalo-pituitary system which influences on the adrenal and genital functions.
(authors' abstract)

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