Posttraumatic hypopituitarism is associated with an unfavorable body composition and lipid profile, and decreased quality of life 12 months after injury.
OBJECTIVE
Our objective was to describe body composition, lipid profile, and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) in relation to the development of posttraumatic hypopituitarism.


METHODS
This is a cross-sectional evaluation with a nested prospective substudy.


METHODS
The cross-sectional cohort included 104 hospitalized patients with TBI [26 females/78 males; median age 41 yr (range 18-64); body mass index (BMI) 25 kg/m(2) (range 17-39); and severity, mild (Glasgow Coma Scale score (GCS) 13-15) n = 44, moderate (GCS 9-12) n = 20, and severe (GCS <9) n = 40)]. A nested cohort of 46 patients was followed prospectively.


METHODS
BMI, waist circumference, lipid profile, total- and regional-fat mass were assessed 3 and 12 months (prospective) or only 12 months (cross-sectional) posttraumatically. HRQL questionnaires (Nottingham Health Profile, EuroQoL-5D, and the GH deficiency (GHD) specific instrument, Quality of Life Assessment of GHD in Adults) were completed "pre-traumatically," 3 and 12 months (prospective), or only 12 months (cross-sectional) posttraumatically.


RESULTS
Patients with posttraumatic hypopituitarism had higher age-, gender-, and BMI-adjusted 12-month low-density lipoprotein-cholesterol, waist circumference, and total fat mass (P < 0.05 in all cases), and a higher increase in total cholesterol (P = 0.01) during follow-up compared with sufficient patients. These findings were unrelated to 12-month IGF-I and IGF-I sd scores. Hypopituitary patients also had worse age, BMI, and TBI severity adjusted overall EuroQoL-5D visual analog scale (P = 0.03) and Quality of Life Assessment of GHD in Adults (P = 0.01) scores, and worse Nottingham Health Profile dimension scores of sleep (P = 0.03), energy (P = 0.02), and social isolation (P = 0.04), compared with patients with an intact pituitary function.


CONCLUSIONS
Posttraumatic hypopituitarism was an independent predictor of the classical phenotypical features of hypopituitarism, including an unfavorable lipid and body composition profile, as well as worsened HRQL.
Klose
M
M
Department of Medical Endocrinology, PE2131, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. mcklose@hotmail.com
Watt
T
T
Brennum
J
J
Feldt-Rasmussen
U
U
D000293:Adolescent; D000328:Adult; D001823:Body Composition; D001930:Brain Injuries / Q000150:complications* / Q000378:metabolism / Q000523:psychology; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology* / Q000378:metabolism / Q000523:psychology; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012890:Sleep; D012934:Social Isolation
D002784:Cholesterol