Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study

Abstract

Objective: Hypopituitarism after traumatic brain injury (TBI) is considered to be a prevalent condition. However, prevalence rates differ considerably among reported studies, due to differences in definitions, endocrine assessments of hypopituitarism, and confounding factors, such as timing of evaluation and the severity of the trauma. Aim: To evaluate the prevalence of hypopituitarism in a large cohort of TBI patients after long-term follow-up using a standardized endocrine evaluation. Study design: Cross-sectional study. Patients and methods:We included 112 patients with TBI, hospitalized for at least 3 days and duration of follow-up O1 year after TBI from five (neurosurgical) referral centers. Evaluation of pituitary function included fasting morning hormone measurements and insulin tolerance test (nZ90) or, when contraindicated, ACTH stimulation and/or CRH stimulation tests and a GH releasing hormonearginine test (nZ22). Clinical evaluation included quality of life questionnaires. Results: We studied 112 patients (75 males), with median age 48 years and mean body mass index (BMI) 26.7G4.8 kg/m 2 . Mean duration of hospitalization was 11 (3-105), and 33% of the patients had a severe trauma (Glasgow Coma Scale !9) after TBI. The mean duration of follow-up was 4 (1-12) years. Hypopituitarism was diagnosed in 5.4% (6/112) of patients: severe GH deficiency (nZ3), hypogonadism (nZ1), adrenal insufficiency (nZ2). Patients diagnosed with pituitary insufficiency had significantly higher BMI (PZ0.002). Conclusion: In this study, the prevalence of hypopituitarism during long-term follow-up after TBI was low. Prospective studies are urgently needed to find reliable predictive tools for the identification of patients with a significant pre-test likelihood for hypopituitarism after TBI.

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

“…There is evidence to demonstrate that following a traumatic brain injury (TBI), patients are at significant risk of developing post-traumatic hypopituitarism (PTHP) (1,2,3,4,5,6,7,8,9,10,11,12,13,14). Following TBI, patients have significantly reduced quality of life (QoL) and cognitive indices (15,16).…”

“…rates of PTHP, partly because of variation in the definitions of GHD, the use of different provocation tests to diagnose GHD and different time points for assessing pituitary function post-TBI (12,22). Furthermore, results of several dynamic function tests are dependent on the BMI of the patient (23), therefore confounding the data.…”

Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism

“…However, recent data from large cohorts raised doubt about the evidence behind such recommendations, as they were unable to confirm the previously reported high prevalence of pituitary dysfunction (2,3,4). Although severe hypopituitarism may certainly present as a complication to brain injury, mostly mild and often irreproducible deficiencies have been reported.…”

Vitamin D Deficiency in Traumatic Brain Injury and Its Relationship with Severity of Injury and Quality of Life: A Prospective, Observational Study

“…(8) Vitamin D has also been found to have a complex modulating action within the immune system,(9-11) has been linked with cardiovascular disease,(12) is known to play a role in multiple cancers (13) and has been widely investigated in other conditions such as multiple sclerosis, type 1 and 2 diabetes mellitus, preeclampsia, rheumatoid arthritis, dementia and metabolic syndrome. (14,15) Within the context of clinical TBI management, endocrinological deficiency and pituitary malfunction are becoming more familiar as longer term post-injury sequelae with pituitary dysfunction and diabetes insipidus demonstrating a prevalence of 5.4% (16) to 19%(17) and 2.9%(18) respectively. To detect these conditions, our unit developed a collaborative post-TBI endocrine screening clinic, operational since July 2013.…”