High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma.
BACKGROUND
Recent data have demonstrated that traumatic brain injury (TBI)-mediated hypopituitarism could be more frequent than previously known. However, most previous data were obtained from retrospective studies.


OBJECTIVE
The aim of this study was to determine 1) the prevalence of anterior pituitary hormone deficiencies in the acute phase of TBI and after 12 months, 2) whether severity of trauma correlated with basal hormone levels, and 3) whether initial hormone deficiencies predicted medium-term hormonal status.


METHODS
Fifty-two TBI patients (43 men and nine women) were included in the prospective study. Pituitary function was evaluated within 24 h of admission and after 1 yr.


RESULTS
Some 5.8% of the patients had TSH deficiency, 41.6% had gonadotropin deficiency, 9.8% had ACTH deficiency, and 20.4% had GH deficiency (GHD). Twelve months after TBI, 5.8% had TSH deficiency, 7.7% had gonadotropin deficiency, 19.2% had ACTH deficiency, and 37.7% had GHD. Twenty-six patients (50.9%) had at least one anterior pituitary hormone deficiency, 21 patients (41.2%) had isolated hormone deficiencies, and five patients (9.7%) had combined hormone deficiencies. Overall, the pituitary hormone deficiencies recovered in 30 (57.7%) patients after 1 yr, and new pituitary hormone deficiencies were present in 27 (51.9%) patients after 1 yr.


CONCLUSIONS
GHD is the most common pituitary deficit 12 months after TBI, and 50.9% of the patients had at least one anterior pituitary hormone deficiency. Pituitary function may improve or worsen in a considerable number of patients over 12 months.
Tanriverdi
Fatih
F
Department of Endocrinology, Erciyes University Medical School, 38039 Kayseri, Turkey.
Senyurek
Hakan
H
Unluhizarci
Kursad
K
Selcuklu
Ahmet
A
Casanueva
Felipe F
FF
Kelestimur
Fahrettin
F
D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006065:Gonadotropins, Pituitary / Q000172:deficiency; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology*; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010903:Pituitary Gland, Anterior / Q000503:physiopathology*; D011446:Prospective Studies; D012306:Risk; D013972:Thyrotropin / Q000172:deficiency
D006065:Gonadotropins, Pituitary; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin