title: Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism.
abstract: OBJECTIVE
  Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment.
  
  
  METHODS
  We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue (MFI-20) were completed in parallel to pituitary assessment.
  
  
  RESULTS
  Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants.
  
  
  CONCLUSIONS
  Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark klose@rh.dk.
authors.forename: Marianne
authors.initials: M
authors.lastname: Klose
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Kirstine
authors.initials: K
authors.lastname: Stochholm
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Jurgita
authors.initials: J
authors.lastname: Janukonyté
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Louise Lehman
authors.initials: LL
authors.lastname: Christensen
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Arieh S
authors.initials: AS
authors.lastname: Cohen
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Aase
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Laurberg
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Jens Sandahl
authors.initials: JS
authors.lastname: Christiansen
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Andersen
authors.affiliation: Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark.
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011788:Quality of Life / Q000523:psychology*; D012042:Registries / Q000706:statistics & numerical data*