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

Cuesta, Martín; Hannon, Mark J; Crowley, Rachel; Behan, Lucy Ann; Tormey, William; Rawluk, Daniel; Delargy, Mark; Agha, Amar; Thompson, Christopher J.

doi:10.1111/cen.12874

Cited by 23 publications

(12 citation statements)

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“…Prevalence of hypogonadism was estimated at about 1.9% to 17.1% ( Alavi, Tan, Menon, Simpson, & Hutchinson, 2016 ; Schneider, Kreitschmann-Andermahr, Ghigo, Stalla, & Agha, 2007 ; Silva et al, 2015 ). Patients with symptoms of hypogonadism (that included ED) after TBI were even more predictive of hypopituitarism than other symptoms (58% vs 16%, P <.0001) ( Cuesta et al, 2016 ). Medications, such as antiepileptic drugs used to prevent posttraumatic seizure, can also attribute organic ED ( Yang & Wang, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that TBI results in problems and disturbances such as inappropriate sexual behaviors and overall sexual dysfunctions in patients after TBI ( Hanks, Sander, Millis, Hammond, & Maestas, 2013 ; Sander, Maestas, Pappadis, Hammond, & Hanks, 2016 ). Several physical factors such as hypogonadism ( Cuesta et al, 2016 ) and prophylactic antiepileptic drugs ( Yang & Wang, 2016 ) could attribute organic ED, in addition to neuropsychological and neuropsychiatric disorders ( Farre, Fora, & Lasheras, 2004 ; Shamloul & Ghanem, 2013 ; Yafi et al., 2016 ). The association between TBI and ED was not studied specifically.…”

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confidence: 99%

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Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

et al. 2018

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Introduction:In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database.Methods:We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000–2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED.Results:After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001).Conclusion:This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it’s crucial in early identification and treatment of ED in post-TBI patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

et al. 2018

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“…ACTH deficiency in UHB patients was defined as a peak cortisol of <550 nmol/l after 250 μg of intramuscular cosyntropin (tetracosactide), according to locally derived normative data. ACTH reserve in the Dublin patient cohort was assessed by measuring the response of cortisol to either the ITT or the glucagon stimulation test (GST) pre‐operatively and 6 weeks postoperatively, as previously described 21. Testing was also performed annually in patients who underwent pituitary RT unless ACTH deficiency was already confirmed.…”

Section: Methodsmentioning

confidence: 99%

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

O’Reilly

Reulen

Gupta

et al. 2016

Clinical Endocrinology

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SummaryContext and ObjectiveNonfunctioning pituitary adenomas (NFPAs) are the most common subtype of pituitary tumour. Hypopituitarism is observed in NFPAs due to tumour‐ or treatment‐related factors and may increase mortality risk. Here, we analysed the associations of hypopituitarism, hormone replacement and mortality in a large NFPA cohort derived from two large European centres.Design, Setting and ParticipantsCase note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1999 and 2014 was performed.Main Outcome MeasuresClinical presentation, treatment strategies, pituitary function and vitality status were recorded in each patient. A multivariate Cox regression model was used to examine the association between hypopituitarism, hormone replacement and premature mortality.ResultsA total of 519 patients were included in the analysis. Median duration of follow‐up was 7·0 years (0·5–43). A total of 81 deaths were recorded (15·6%). On multivariate analysis, adrenocorticotropic hormone (ACTH) and gonadotropin (Gn) deficiencies were associated with an increased relative risk of death (OR 2·26, 95% CI 1·15–4·47, P = 0·01 and OR 2·56, 95% CI 1·10–5·96, P = 0·01, respectively). Increased hydrocortisone (HC) (P‐trend = 0·02) and lower levothyroxine (LT4) doses (P‐trend = 0·03) were associated with increased risk of death. Mortality increased with the degree of pituitary failure observed (P‐trend = 0·04).ConclusionACTH and gonadotropin‐deficient patients have higher mortality rates compared to those with intact hormonal axes. Excessive HC and suboptimal LT4 replacement may also increase risk of death. Complex associations between hormone deficiency and replacement underpin the increased mortality risk in NFPA patients.

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“…We adopted these suggestions into routine surveillance programmes and recently published the results of an audit of the use of symptoms as predictors of hypopituitarism. We showed that symptoms of hypogonadism, such as menstrual dysfunction, erectile dysfunction or loss of libido are strongly predictive of hypopituitarism, but nonspecific symptoms such as weight loss and anergia are no more predictive than unselected screening in identifying pituitary hormone deficits (109).…”

Section: Chronic Hypopituitarismmentioning

confidence: 84%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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

Abstract: Symptoms of hypogonadism are sufficiently predictive of hypopituitarism to justify screening for hypopituitarism after moderate/severe TBI. Nonspecific symptoms of hypopituitarism are no more predictive than unselected screening.

Cited by 23 publications

References 32 publications

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

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