Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study.
BACKGROUND
Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism.


OBJECTIVE
The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury.


METHODS
Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32).


RESULTS
In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency.


CONCLUSIONS
There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.
Aimaretti
Gianluca
G
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, C.so Dogliotti, 14, 10126 Turin, Italy.
Ambrosio
Maria Rosaria
MR
Di Somma
Carolina
C
Gasperi
Maurizio
M
Cannavò
Salvatore
S
Scaroni
Carla
C
Fusco
Alessandra
A
Del Monte
Patrizia
P
De Menis
Ernesto
E
Faustini-Fustini
Marco
M
Grimaldi
Franco
F
Logoluso
Francesco
F
Razzore
Paola
P
Rovere
Silvia
S
Benvenga
Salvatore
S
Degli Uberti
Ettore Ciro
EC
De Marinis
Laura
L
Lombardi
Gaetano
G
Mantero
Franco
F
Martino
Enio
E
Giordano
Giulio
G
Ghigo
Ezio
E
D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D007018:Hypopituitarism / Q000503:physiopathology*; D008297:Male; D010902:Pituitary Gland / Q000503:physiopathology*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology*
D019382:Human Growth Hormone