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

Abstract

Objective: Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. Design and methods: We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue were completed in parallel to pituitary assessment. Results: Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. Conclusions: Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.

Chronic Hypopituitarism Associated with Increased Postconcussive Symptoms Is Prevalent after Blast-Induced Mild Traumatic Brain Injury

“…A wide range of values (from 5 to 90%) for the prevalence of PTHP in civilians has been reported in 40-plus studies since 2000 with most finding a range of 25–50% ( 27 , 45 ). The large variance is due to differences in the populations sampled, injury severity, time since injury, hormone measurement methods, and screening and clinical diagnostic criteria ( 46 , 47 ). We employed clearly defined screening criteria calculated from the distribution of basal morning concentrations of each hormone in a reference population.…”

Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury

“…Hellawell and colleagues found that 1 year after moderate or severe traumatic brain injury up to 60% of patients presented with symptoms similar to those of hypopituitarism . TBI patients are known to present with fatigue, deterioration of sex life and a feeling of social isolation, increased body fat and decreased lean body mass, and reduced muscle strength and dyslipidemia . Although referring clinicians were not endocrinologists in our series, a clinical endocrinologist had also seen the patient prior to testing, so it seems unlikely that the nonsuperiority of symptom‐based testing over random testing reflects lack of endocrine clinical acumen in the referring physicians.…”

Addisonian Crisis after Missed Diagnosis of Posttraumatic Hypopituitarism

“…Since individuals after TBI commonly suffer from a myriad of neurological, somatic and psychiatric sequelae of the trauma, it is difficult to ascertain which of the presented clinical symptoms may also be caused or aggravated by neuroendocrine dysfunction. A recent study from a Danish group found only a very limited relationship between hormonal dysfunction and quality of life or fatigue 2.5 years (median) after TBI [7]. These controversies and the lack of established, clear-cut risk markers for posttraumatic anterior hypopituitarism may account for the fact, that routine testing for endocrine dysfunction in TBI survivors is not widely performed in clinical practice [8].…”