title: Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury.
abstract: OBJECTIVE
  The economic and logistic burden of screening for hypopituitarism following moderate/severe traumatic brain injury (TBI) is considerable. A key recommendation in published guidelines is to prioritize for screening those patients with symptoms suggestive of pituitary dysfunction. The purpose of this study was to evaluate the utility of targeted screening for hypopituitarism in long-term survivors after moderate/severe TBI using referrals on the basis of symptoms.
  
  
  METHODS
  In group 1 (G1), consecutive, unselected patients were screened from the Irish National Neurosurgery Centre, whereas in group 2 (G2) patients were targeted based on the presence of symptoms suggestive of pituitary dysfunction.
  
  
  METHODS
  A total of 137 patients (113 male) were systematically screened (G1) and compared to 112 patients (77 male) referred for pituitary evaluation on the basis of suggestive symptoms (G2).
  
  
  METHODS
  The rate of GH, ACTH, gonadotrophin (GT), TSH and ADH deficiency was compared among groups.
  
  
  RESULTS
  Patients referred with menstrual dysfunction had more GH (50% vs 11%, P = 0·001), ACTH (60% vs 14%, P < 0·0001), GT (90% vs 16%, P < 0·0001) deficiency and any pituitary hormone deficit (80% vs 33%, P = 0·003) than G1. Men with symptoms of hypogonadism had more GH (33% vs 11%, P = 0·003), GT (58% vs 16%, P < 0·0001) and TSH (16% vs 1%, P = 0·03) deficiency than G1. Patients with nonspecific symptoms were no more likely to have hypopituitarism than those consecutively screened.
  
  
  CONCLUSIONS
  Symptoms of hypogonadism are sufficiently predictive of hypopituitarism to justify screening for hypopituitarism after moderate/severe TBI. Nonspecific symptoms of hypopituitarism are no more predictive than unselected screening.
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Martín
authors.initials: M
authors.lastname: Cuesta
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hannon
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Rachel K
authors.identifier: http://orcid.org/0000-0003-1472-4117
authors.initials: RK
authors.lastname: Crowley
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Lucy Ann
authors.initials: LA
authors.lastname: Behan
authors.affiliation: Department of Chemical Pathology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: William
authors.initials: W
authors.lastname: Tormey
authors.affiliation: National Neurosurgery Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rawluk
authors.affiliation: National Rehabilitation Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Delargy
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Amar
authors.initials: A
authors.lastname: Agha
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006062:Gonadotropins / Q000032:analysis; D006801:Humans; D007006:Hypogonadism / Q000175:diagnosis / Q000503:physiopathology*; D007018:Hypopituitarism / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D010902:Pituitary Gland / Q000503:physiopathology*; D010907:Pituitary Hormones / Q000032:analysis; D011379:Prognosis; D017741:Survivors / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D055815:Young Adult
chemical_list: D006062:Gonadotropins; D010907:Pituitary Hormones