title: Predictors of Hypopituitarism in Patients with Traumatic Brain Injury.
abstract: Hypopituitarism may often occur in association with traumatic brain injury (TBI). Identification of reliable predictors of pituitary dysfunction is of importance in order to establish a rational testing approach. We searched the records of patients with TBI, who underwent neuroendocrine evaluation in our institution between 2007 and 2013. One hundred sixty-six adults (70% men) with TBI (median age: 41.6 years; range: 18-76) were evaluated at a median interval of 40.4 months (0.2-430.4).Of these, 31% had ≥1 pituitary deficiency, including 29% of patients with mild TBI and 35% with moderate/severe TBI. Growth hormone deficiency was the most common deficiency (21%); when body mass index (BMI)-dependent cutpoints were used, this was reduced to 15%. Central hypoadrenalism occurred in10%, who were more likely to have suffered a motor vehicle accident (MVA, p = 0.04), experienced post-traumatic seizures (p = 0.04), demonstrated any intracranial hemorrhage (p = 0.05), petechial brain hemorrhages (p = 0.017), or focal cortical parenchymal contusions (p = 0.02). Central hypothyroidism occurred in 8% and central hypogonadism in 12%; the latter subgroup had higher BMI (p = 0.03), were less likely to be working after TBI (p = 0.002), and had lower Global Assessment of Functioning (GAF) scores (p = 0.03). Central diabetes insipidus (DI) occurred in 6%, who were more likely to have experienced MVA (p < 0.001) or sustained moderate/severe TBI (p < 0.001). Patients with MVA and those with post-traumatic seizures, intracranial hemorrhage, petechial brain hemorrhages, and/or focal cortical contusions are at particular risk for serious pituitary dysfunction, including adrenal insufficiency and DI, and should be referred for neuroendocrine testing. However, a substantial proportion of patients without these risk factors also developed hypopituitarism.
authors.affiliation: 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Paula P B
authors.initials: PP
authors.lastname: Silva
authors.affiliation: 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Saurabha
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Seth D
authors.initials: SD
authors.lastname: Herman
authors.affiliation: 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
authors.affiliation: 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
authors.affiliation: 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
authors.affiliation: 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Tritos
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000209:etiology; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D020201:Brain Hemorrhage, Traumatic / Q000209:etiology / Q000473:pathology; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D003919:Diabetes Insipidus; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D007006:Hypogonadism / Q000209:etiology / Q000473:pathology; D007018:Hypopituitarism / Q000209:etiology* / Q000473:pathology; D007037:Hypothyroidism / Q000209:etiology / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone
keywords: adrenal insufficiency; diabetes insipidus; growth hormone deficiency; hypogonadism; hypopituitarism; hypothyroidism; traumatic brain injury