Prevalence and predictive factors of post‐traumatic hypopituitarism

Klose, Marianne; Juul, Anders; Poulsgaard, Lars; Kosteljanetz, Michael; Brennum, Jannick; Feldt‐Rasmussen, Ulla

doi:10.1111/j.1365-2265.2007.02860.x

Cited by 147 publications

(131 citation statements)

References 30 publications

(81 reference statements)

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“…In all the 30 patients with Mod/STBI participating in our study, anterior pituitary function was normal. The prevalence of hypopituitarism after TBI that we report is considerably lower than the prevalences reported by recent studies (15-56%) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The aim of our study was to evaluate anterior pituitary function in a patient cohort representative for all the patients with TBI.…”

Section: Discussioncontrasting

confidence: 44%

“…In these previous studies (5,(7)(8)(9)(10)(11)(12)(13)(14), the percentage of patients with Mod/STBI was higher (56-100%) than that of the patients in our study. In addition to the differences in the study cohorts, the wide range of reported prevalences of hypopituitarism (varying from 15 to 56%) may be attributed to the differences in diagnostic criteria (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Furthermore, some studies included patients in whom, besides a history of TBI, alternative causes of pituitary dysfunction had not been ruled out, such as pre-existent hypopituitarism (6-10, 12, 14), BMI above 30 kg/m 2 (5-10, 12-14), and substance abuse (6-10, 12).…”

Section: Discussionmentioning

confidence: 76%

“…In some previous studies, no association of pituitary dysfunction with TBI severity was reported (6,7,(10)(11)(12)(13), whereas others found pituitary dysfunction to be more prevalent in patients with more severe TBI (5,14). In their systematic review, Schneider et al pooled the reported prevalences in severe (35.3%, 95% CI 27.3-44.2%), Mod (10.9%, 95% CI 5.1-21.8%), and MTBI (16.8%, 95% CI 10.9-25.0%) (22), showing that the risk of pituitary dysfunction is higher in patients with STBI than in patients with a MTBI.…”

Section: Discussionmentioning

confidence: 97%

“…Consequently, the population in which the prevalence of pituitary dysfunction was assessed remained insufficiently defined. Contrary to our study, patients who were evaluated in all previous studies were selected from hospitalized patient populations only (at a general ward (5,7,8,10,13,14), at an ICU (9,12), or at a rehabilitation institute (11)). Therefore, these studies included patients with more severe brain injury.…”

Section: Discussionmentioning

confidence: 99%

“…Involvement of the posterior pituitary gland during the acute phase after severe head trauma has been acknowledged for years, but trauma-induced anterior pituitary dysfunction was considered rare (4). However, several recent studies have reported of a high frequency of anterior pituitary hormone insufficiency between 2 weeks and 1.5 years after TBI, varying from 15 to 56% of patients with moderate or severe TBI (Mod/STBI) (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Eerden¹,

Twickler

Sweep³

et al. 2010

European Journal of Endocrinology

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Context: A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients. Objective: To assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients using strict endocrinological diagnostic criteria. Methods: Of all the patients presenting in the emergency department with TBI over a 2-year period, 516 matched the inclusion criteria. One hundred and seven patients (77 with mild TBI and 30 with moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH-arginine testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17b-estradiol or testosterone), and menstrual history 3-30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH-arginine, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH stimulation test, and repeated GHRH-arginine test) and assessment of free testosterone levels. Results: Screening results were abnormal in 15 of 107 patients. In a subsequent extensive endocrine evaluation, anterior pituitary dysfunction was diagnosed in only one patient (partial hypocortisolism). Conclusion: By applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients, it was shown that anterior pituitary dysfunction is rare (!1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Eerden¹,

Twickler

Sweep³

et al. 2010

European Journal of Endocrinology

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Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage

Schneider

Kreitschmann-Andermahr²,

Ghigo³

et al. 2007

JAMA

463

366

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Context Neuroendocrine dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage may occur with a much higher prevalence than previously suspected. This sequela is a potentially serious but treatable complication of brain injury.Objective To review research on hypothalamopituitary dysfunction as an underdiagnosed consequence of traumatic brain injury and subarachnoid hemorrhage, the natural history of this complication, and the potential clinical and public health implications of posttraumatic hypopituitarism. Evidence AcquisitionThe MEDLINE database was searched for articles published between 2000 and 2007 using any combination of the terms traumatic brain injury or subarachnoid hemorrhage with pituitary, hypopituitarism, growth hormone deficiency, hypogonadism, hypocortisolism, hypothyroidism, or diabetes insipidus. The reference lists of articles identified by this search strategy were also searched. All articles reporting original data on endocrine outcomes after traumatic brain injury or aneurysmal subarachnoid hemorrhage in peer-reviewed journals with regard to prevalence, pathogenesis, risk factors, outcomes, and clinical course were selected. We pooled data and calculated prevalence rates and 95% confidence intervals (CIs). ResultsWe identified 19 studies including 1137 patients. The pooled prevalences of hypopituitarism in the chronic phase after traumatic brain injury and aneurysmal subarachnoid hemorrhage were 27.5% (95% confidence interval [CI], 22.8%-28.9%) and 47% (95% CI, 37.4%-56.8%), respectively. The pooled prevalence of hypopituitarism was greater in patients with severe compared with those with mild or moderate traumatic brain injury. Early neuroendocrine abnormalities were transient in some patients while, less commonly, hypopituitarism evolved over time in others. Patients with posttraumatic hypopituitarism showed an impaired quality of life and an adverse metabolic profile. ConclusionHypopituitarism is a common complication of both traumatic brain injury and aneurysmal subarachnoid hemorrhage and might contribute to morbidity and poor recovery after brain injury.

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Endocrine Disturbances Following TBI

Tepe

Guerrero

2012

Traumatic Brain Injury

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Prevalence and predictive factors of post‐traumatic hypopituitarism

Cited by 147 publications

References 30 publications

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage

Endocrine Disturbances Following TBI

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