Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?
BACKGROUND
A wide range (15-56%) of prevalences of anterior pituitary insufficiency are reported in patients after traumatic brain injury (TBI). However, different study populations, study designs, and diagnostic procedures were used. No data are available on emergency-department-based cohorts of TBI patients.


OBJECTIVE
To assess the prevalence of pituitary dysfunction in an emergency-department-based cohort of TBI patients using strict endocrinological diagnostic criteria.


METHODS
Of all the patients presenting in the emergency department with TBI over a 2-year period, 516 matched the inclusion criteria. One hundred and seven patients (77 with mild TBI and 30 with moderate/severe TBI) agreed to participate. They were screened for anterior pituitary insufficiency by GHRH-arginine testing, evaluation of fasting morning hormone levels (cortisol, TSH, free thyroxine, FSH, LH, and 17beta-estradiol or testosterone), and menstrual history 3-30 months after TBI. Abnormal screening results were defined as low peak GH to GHRH-arginine, or low levels of any of the end-organ hormones with low or normal pituitary hormone levels. Patients with abnormal screening results were extensively evaluated, including additional hormone provocation tests (insulin tolerance test, ACTH stimulation test, and repeated GHRH-arginine test) and assessment of free testosterone levels.


RESULTS
Screening results were abnormal in 15 of 107 patients. In a subsequent extensive endocrine evaluation, anterior pituitary dysfunction was diagnosed in only one patient (partial hypocortisolism).


CONCLUSIONS
By applying strict diagnostic criteria to an emergency-department-based cohort of TBI patients, it was shown that anterior pituitary dysfunction is rare (<1%). Routine pituitary screening in unselected patients after TBI is unlikely to be cost-effective.
Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Anke W
AW
van der Eerden
Marcel Th B
MT
Twickler
Fred C G J
FC
Sweep
Tjemme
T
Beems
Henk T
HT
Hendricks
Ad R M M
AR
Hermus
Pieter E
PE
Vos
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000097:blood* / Q000150:complications; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010901:Pituitary Function Tests / Q000379:methods; D010903:Pituitary Gland, Anterior / Q000502:physiology*; D010908:Pituitary Hormones, Anterior / Q000097:blood*; D055815:Young Adult
D010908:Pituitary Hormones, Anterior