title: Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a German multi-centre screening program.
abstract: BACKGROUND
  We determined the prevalence of anterior pituitary dysfunction in a multi-centre screening program across five German endocrine centres in patients rehabilitating from TBI (GCS<13).
  
  
  METHODS
  246 patients (39+/-14 yrs; 133 males, 12+/-8 months after TBI) underwent a series of baseline endocrine tests with central assessment of TSH, free T4, prolactin, LH, FSH, testosterone (m), estradiol (f), cortisol, GH, and IGF-I. If IGF-I was <-2 SDS dynamic testing was performed. GHD was defined according to BMI-dependent cut-off values for GH response to GHRH+arginine of <4.2, <8.0 and <11.5 ng/ml in obese, overweight and lean subjects, respectively, or <3 micro g/l in ITT. Hypocortisolism was suggested when basal cortisol was <200 nmol/l and confirmed by ITT (peak<500 nmol/l).
  
  
  RESULTS
  In TBI patients some degree of impaired pituitary function was shown in 21% (n=52/246). Total, multiple and isolated deficits were present in 1%, 2% and 18%, respectively. 19% had an IGF-I of <-1 SDS, 9% of <-2 SDS. In 5% GHD was confirmed. 9% had hypogonadism. 4% had hypocortisolism and 1% of patients had confirmed ACTH-deficiency. 12% had TSH-deficiency.
  
  
  CONCLUSIONS
  In summary, in this large series carried out on an unselected group of TBI survivors we have found hypopituitarism in every fifth patient with predominantly secondary hypogonadism and hypothyreosis. Regarding somatotrope insufficiency IGF-I is decreased in 50% of GHD patients.
  
  
  CONCLUSIONS
  These findings strongly suggest that patients who suffer head trauma should routinely undergo endocrine evaluation.
authors.affiliation: Clinic of Endocrinology, University Hospital of Essen, Germany. christian.berg@uni-essen.de
authors.forename: C
authors.initials: C
authors.lastname: Berg
authors.forename: A
authors.initials: A
authors.lastname: Oeffner
authors.forename: P-M
authors.initials: PM
authors.lastname: Schumm-Draeger
authors.forename: F
authors.initials: F
authors.lastname: Badorrek
authors.forename: G
authors.initials: G
authors.lastname: Brabant
authors.forename: B
authors.initials: B
authors.lastname: Gerbert
authors.forename: S
authors.initials: S
authors.lastname: Bornstein
authors.forename: A
authors.initials: A
authors.lastname: Zimmermann
authors.forename: M
authors.initials: M
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Broecker-Preuss
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.forename: B L
authors.initials: BL
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000097:blood / Q000150:complications* / Q000534:rehabilitation; D004958:Estradiol / Q000097:blood; D005260:Female; D005858:Germany; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D010908:Pituitary Hormones, Anterior / Q000097:blood*; D015995:Prevalence; D013739:Testosterone / Q000097:blood
chemical_list: D010908:Pituitary Hormones, Anterior; D013739:Testosterone; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone