Anterior Pituitary Hormone Abnormalities following Traumatic Brain Injury

Schneider, Max; Schneider, Harald J.; Stalla, Günter

doi:10.1089/neu.2005.22.937

Cited by 53 publications

(33 citation statements)

References 65 publications

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“…Typical clinical consequences of TBI are disorders of consciousness, attention deficits, impulsion impairment, depression and sleep. Some of these symptoms might also be a consequence of anterior pituitary insufficiency (5,6). Therefore, it is possible that post-traumatic hypopituitarism often remains unrecognized due to masking by TBI sequelae, and that symptoms of TBI might be aggravated by hypopituitarism.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury

Schneider

Saller³

et al. 2006

eur j endocrinol

197

191

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Objective: Cross-sectional studies report a high prevalence of hypopituitarism after traumatic brain injury (TBI); however, no longitudinal studies on time of manifestation and reversibility exist. This study was conducted to assess hypopituitarism 3 and 12 months after TBI. Design: This was a prospective, longitudinal, diagnostic study. Methods: Seventy-eight patients (52 men, 26 women, mean age 36.0 years) with TBI grades I -III and 38 healthy subjects (25 men, 13 women, mean age 36.4 years) as a control group for the GHRH þ arginine test were studied. The prevalence ofhypopituitarism was assessed 3 and 12 months after TBI by GHRH þ arginine test, short adrenocorticotropic hormone (ACTH) test, and basal hormone measurements in patients. Results: After 3 months, 56% of all patients had impairments of at least one pituitary axis with axes being affected as follows: gonadotropic 32%, corticotropic 19%, somatotropic 9% and thyrotropic 8%. After 12 months, fewer patients were affected, but in some cases new impairments occurred; 36% still had impairments. The axes were affected as follows after 12 months: gonadotropic 21%, somatotropic 10%, corticotropic 9% and thyrotropic 3%. Conclusions: Hypopituitarism occurs often in the post-acute phase after TBI and may normalize later, but may also develop after the post-acute phase of TBI.European Journal of Endocrinology 154 259-265

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Section: Introductionmentioning

confidence: 99%

Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury

Schneider

Saller³

et al. 2006

eur j endocrinol

197

191

View full text Add to dashboard Cite

show abstract

“…The mechanisms involved herein are still poorly understood. Necrosis, infarction, and hemorrhage into the pituitary and hypothalamus were found in a large proportion of subjects, who did not survive traumatic brain injury and subarachnoid hemorrhage (reviewed in (12)). These factors could also play a potential role in survivors.…”

Section: Introductionmentioning

confidence: 99%

Endocrine dysfunction in patients operated on for non-pituitary intracranial tumors

et al. 2006

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Objective: Hypopituitarism frequently follows pituitary neurosurgery (NS) and/or irradiation. However, the frequency of hypothalamic-pituitary dysfunction after NS of non-pituitary intracranial tumors is unclear. The aim of this study was to assess the presence of endocrine alterations in patients operated on for intracranial tumors. Design: This is a retrospective study. Methods: We studied 68 consecutive adult patients (28 female, 40 male, age 45.0G1.8 years; body mass index (BMI): 26.5G0.6) with intracranial tumors who underwent NS only (nZ17) or in combination with radiotherapy (RT) and/or chemotherapy (CT) (nZ51). In all subjects, basal endocrine parameters and the GH response to GHRHCarginine test (using BMI-dependent cut offs) were evaluated. Results: In 20.6% of the patients, peripheral endocrinopathy related to CT and/or RT was present. Hypopituitarism was found in 38.2% of the patients. Total pituitary hormone, multiple pituitary hormone, and isolated pituitary hormone deficits were present in 16.2, 5.8, and 16.2% respectively. The most common pituitary deficits were, in decreasing order: LH/FSH 29.4%, GH 27.9%, ACTH 19.1%, TSH 17.7%, and diabetes insipidus 4.4%. Hyperprolactinemia was present in 13.2%. The prevalence of hypopituitarism was higher in patients who underwent NS only and with tumors located closely to the sella turcica, but a substantial proportion of patients with tumors not directly neighboring the sella also showed hypopituitarism. Conclusions: Hypopituitarism frequently occurs after NS for intracranial tumors. Also, exposure of these patients to CT and/or RT is frequently associated with peripheral endocrinopathies. Thus, endocrine evaluation and follow-up of patients treated for intracranial tumors should be performed on a regular basis.European Journal of Endocrinology 155 559-566

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“…Exclusion of secondary adrenocortical insufficiency with 100% sensitivity is achieved, however, only with serum cortisol increases >515-615 nmol/l (18. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].0 lg/dl) [9,11]. Hence, the existing diagnostic ''gap'' is relatively wide and sensitivity, as well as specificity, of the CRH test is lower compared to the insulin-induced hypoglycemia test.…”

Section: Secondary Adrenal Insufficiencymentioning

confidence: 99%

“…Recent studies suggest a high incidence of hypopituitarism in patients with traumatic brain injury (TBI) [2][3][4][5]. Based on the high incidence of TBI of approximately 100/100,000 and approximately 30% of all patients with TBI presenting with some form of hypopituitarism [6], awareness of TBI-related hypopituitarism might significantly increase the total number of patients with hypopituitarism requiring care. The aim of this study is to review current knowledge on clinically relevant aspects in the functional diagnosis and treatment of adult hypopituitarism.…”

Section: Introductionmentioning

confidence: 99%

Anterior pituitary hormone replacement therapy—a clinical review

Auernhammer

Vlotides

2007

Pituitary

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This clinical review summarizes current approaches to diagnosis and treatment of anterior pituitary hormone deficiency. The diagnostic value of endocrine function tests and replacement strategies for hydrocortisone, thyroxine, sex steroids, and growth hormone replacement are reviewed. Female androgen deficiency syndrome and the current role of DHEA and testosterone replacement in women are also discussed.

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Anterior Pituitary Hormone Abnormalities following Traumatic Brain Injury

Cited by 53 publications

References 65 publications

Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury

Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury

Endocrine dysfunction in patients operated on for non-pituitary intracranial tumors

Anterior pituitary hormone replacement therapy—a clinical review

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