title: Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury.
abstract: OBJECTIVE
  Traumatic brain injury (TBI) has been associated with hypopituitarism and GH deficiency. However, TBI-mediated hypopituitarism may be more frequent than previously thought. The present work, performed in patients with severe TBI at least 1 year before, had three aims: (i) to evaluate the prevalence of hypopituitarism, (ii) in particular to evaluate the prevalence of GH deficiency, and (iii) to compare three different tests of GH reserve in this cohort.
  
  
  METHODS
  From a nonselected group of 249 patients admitted to our Clinical Centre for severe TBI over the last 5 years, 200 of them answered a custom made questionnaire of symptoms of hypopituitarism enclosed in the invitation letter to participate in the study. A total of 170 (99 men and 14 women), accepted to participate in the study (study cohort); 57 had normal questionnaires and were not further studied, 14 discontinued the study, and 99 attended the hospital for dynamic tests of pituitary hormone deficiencies. From these, 44 subjects with IGF-I in the lower range were tested with GHRH+GHRP-6; ITT; and glucagon tests of GH reserve, on three different occasions.
  
  
  METHODS
  Pituitary hormones plus IGF-I and target gland hormones were analysed.
  
  
  RESULTS
  With regard to the initial cohort of 170 subjects (100%), three (1.7%) showed diabetes insipidus; 10 (5.8%) TSH deficiency, 11 (6.4%) ACTH deficiency and 29 (17%) gonadotrophin deficiency. In 10 subjects (5.8%), GH deficiency was diagnosed by strict criteria. Finally, 15 (8.8%) showed combined deficit of several hormones.
  
  
  CONCLUSIONS
  After severe head trauma, gonadotrophin deficiency was the most common pituitary deficit. GH deficiency showed a prevalence similar to ACTH and TSH deficits, i.e. near 6% of the cohort. Taken together, 24.7% of the subjects studied showed any type of pituitary hormone deficiency.
authors.affiliation: Division of Endocrinology, Vorgem del Rocio University Hospital, Sevilla, Spain. alfonso.leal@infonegocio.com
authors.forename: Alfonso
authors.initials: A
authors.lastname: Leal-Cerro
authors.forename: Juan M
authors.initials: JM
authors.lastname: Flores
authors.forename: Marilo
authors.initials: M
authors.lastname: Rincon
authors.forename: Francisco
authors.initials: F
authors.lastname: Murillo
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pujol
authors.forename: Felipe
authors.initials: F
authors.lastname: Garcia-Pesquera
authors.forename: Carlos
authors.initials: C
authors.lastname: Dieguez
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000097:blood / Q000150:complications*; D003919:Diabetes Insipidus / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006065:Gonadotropins, Pituitary / Q000097:blood / Q000172:deficiency; D013006:Growth Hormone / Q000097:blood / Q000172:deficiency*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007018:Hypopituitarism / Q000175:diagnosis / Q000209:etiology*; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D013972:Thyrotropin / Q000097:blood / Q000172:deficiency; D013997:Time Factors
chemical_list: D006065:Gonadotropins, Pituitary; D007334:Insulin-Like Growth Factor I; D013972:Thyrotropin; D013006:Growth Hormone; D006854:Hydrocortisone