Patterns of pituitary dysfunction three months or more after traumatic brain injury

Abstract

Purpose: Chronic posttraumatic brain injury (TBI) pituitary dysfunction is not a newly discovered subject, it has been reported more frequently, probably due to increasing chances of exposure to its causes, mainly the road traffic accidents, sport-related injuries, falls, and injuries during wars. This study aims to estimate the frequency of pituitary dysfunction 3 months or more after head trauma and the patterns of hormonal deficiencies. Methods: A cross-sectional study was conducted between January 2016 and August 2017. Participants were patients having a history of moderate-to-severe TBI at least 3 months before enrolment. Pituitary function test was done for all patients to determine the frequency of pituitary dysfunction, the number of axes deficiencies, and which hormone is mostly affected. Statistical Package for the Social Sciences (SPSS) version 23.0 was used for univariate analysis, P < 0.05 was considered statistically significant. Results: Out of the 28 patients involved in this study, 17 (61%) had pituitary dysfunction, while 11 (39%) had not. Single hormonal defect was the most prevalent abnormality in 12 (43%), and the most affected hormone was the growth hormone (GH) in 14 patients (50%), followed by gonadal axis, thyroid stimulating hormone, and finally adrenocorticotropic hormone (ACTH), 6 (21%), 3 (11%), and 1 (4%), respectively. Conclusion: TBI pituitary dysfunction is more prevalent than was predicted in the population studied, single hormonal defect was found to be the most prevalent abnormality, being the GH is the most affected axis, and the ACTH seems to be the least.

Keywords

Growth hormone deficiency - head trauma - hypopituitarism - traumatic brain injury

Publication History

Article published online:
12 August 2021

• References

• 1 Tanriverdi F, Schneider HJ, Aimaretti G, Masel BE, Casanueva FF, Kelestimur F. et al. Pituitary dysfunction after traumatic brain injury: A clinical and pathophysiological approach. Endocr Rev 2015; 36: 305-42
• 2 Menon DK, Schwab K, Wright DW, Maas AI. Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: Definition of traumatic brain injury. Arch Phys Med Rehabil 2010; 91: 1637-40
• 3 Teasdale G, Jennett B. Assessment of coma and impaired consciousness A practical scale. Lancet 1974; 2: 81-4
• 4 Consensus conference. Rehabilitation of persons with traumatic brain injury. NIH consensus development panel on rehabilitation of persons with traumatic brain injury. JAMA 1999;282:974‑83.
• 5 Maiya B, Newcombe V, Nortje J, Bradley P, Bernard F, Chatfield D. et al. Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury. Intensive Care Med 2008; 34: 468-75
• 6 Salehi F, Kovacs K, Scheithauer BW, Pfeifer EA, Cusimano M. Histologic study of the human pituitary gland in acute traumatic brain injury. Brain Inj 2007; 21: 651-6
• 7 Tanriverdi F, De Bellis A, Bizzarro A, Sinisi AA, Bellastella G, Pane E. et al. Antipituitary antibodies after traumatic brain injury: Is head trauma-induced pituitary dysfunction associated with autoimmunity. Eur J Endocrinol 2008; 159: 7-13
• 8 Nakase-Richardson R, Sherer M, Seel RT, Hart T, Hanks R, Arango-Lasprilla JC. et al. Utility of post-traumatic amnesia in predicting 1-year productivity following traumatic brain injury: Comparison of the russell and mississippi PTA classification intervals. J Neurol Neurosurg Psychiatry 2011; 82: 494-9
• 9 Aimaretti G, Baffoni C, DiVito L, Bellone S, Grottoli S, Maccario M. et al. Comparisons among old and new provocative tests of GH secretion in 178 normal adults. Eur J Endocrinol 2000; 142: 347-52
• 10 Karaca Z, Lale A, Tanriverdi F, Kula M, Unluhizarci K, Kelestimur F. et al. The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults. Pituitary 2011; 14: 134-40
• 11 Ferretti E, Persani L, Jaffrain-Rea ML, Giambona S, Tamburrano G, Beck-Peccoz P. et al. Evaluation of the adequacy of levothyroxine replacement therapy in patients with central hypothyroidism. J Clin Endocrinol Metab 1999; 84: 924-9
• 12 Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ. American Association of Clinical Endocrinologists, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients–2002 update. Endocr Pract 2002; 8: 440-56
• 13 Schneider HJ, Schneider M, Saller B, Petersenn S, Uhr M, Husemann B. et al. Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury. Eur J Endocrinol 2006; 154: 259-65
• 14 Leal-Cerro A, Flores JM, Rincon M, Murillo F, Pujol M, Garcia-Pesquera F. et al. Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury. Clin Endocrinol (Oxf) 2005; 62: 525-32
• 15 Kokshoorn NE, Smit JW, Nieuwlaat WA, Tiemensma J, Bisschop PH, Groote Veldman R. et al. Low prevalence of hypopituitarism after traumatic brain injury: A multicenter study. Eur J Endocrinol 2011; 165: 225-31
• 16 Masel BE, Zgaljardic DJ, Forman J. Post-traumatic hypopituitarism and fatigue. Neuropsychol Rehabil 2017; 27: 1071-9
• 17 Aimaretti G, Ambrosio MR, Di Somma C, Gasperi M, Cannavò S, Scaroni C. et al. Residual pituitary function after brain injury-induced hypopituitarism: A prospective 12-month study. J Clin Endocrinol Metab 2005; 90: 6085-92
• 18 Agha A, Rogers B, Sherlock M, O'Kelly P, Tormey W, Phillips J. et al. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 2004; 89: 4929-36
• 19 Tanriverdi F, Senyurek H, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F. et al. High risk of hypopituitarism after traumatic brain injury: A prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma. J Clin Endocrinol Metab 2006; 91: 2105-11
• 20 Popovic V, Pekic S, Pavlovic D, Maric N, Jasovic-Gasic M, Djurovic B. et al. Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress. J Endocrinol Invest 2004; 27: 1048-54
• 21 Klose M, Juul A, Poulsgaard L, Kosteljanetz M, Brennum J, Feldt-Rasmussen U. et al. Prevalence and predictive factors of post-traumatic hypopituitarism. Clin Endocrinol (Oxf) 2007; 67: 193-201
• 22 Bondanelli M, De Marinis L, Ambrosio MR, Monesi M, Valle D, Zatelli MC. et al. Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 2004; 21: 685-96
• 23 Schneider M, Schneider HJ, Yassouridis A, Saller B, von Rosen F, Stalla GK. et al. Predictors of anterior pituitary insufficiency after traumatic brain injury. Clin Endocrinol (Oxf) 2008; 68: 206-12
• 24 Preiss-Farzanegan SJ, Chapman B, Wong TM, Wu J, Bazarian JJ. et al. The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R 2009; 1: 245-53
• 25 Schneider HJ, Sämann PG, Schneider M, Croce CG, Corneli G, Sievers C. et al. Pituitary imaging abnormalities in patients with and without hypopituitarism after traumatic brain injury. J Endocrinol Invest 2007; 30: RC9-12
• 26 Ghigo E, Masel B, Aimaretti G, Léon-Carrión J, Casanueva FF, Dominguez-Morales MR. et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj 2005; 19: 711-24
• 27 Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S. et al. Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study. Ann Neurol 2013; 74: 527-36
• 28 Kelly DF, Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C. et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: A preliminary report. J Neurosurg 2000; 93: 743-52
• 29 Yang WH, Chen PC, Wang TC, Kuo TY, Cheng CY, Yang YH. et al. Endocrine dysfunction following traumatic brain injury: A 5-year follow-up nationwide-based study. Sci Rep 2016; 6: 32987
• 30 Lieberman SA, Oberoi AL, Gilkison CR, Masel BE, Urban RJ. et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 2001; 86: 2752-6
• 31 Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA, Bellastella G. et al. A five year prospective investigation of anterior pituitary function after traumatic brain injury: Is hypopituitarism long-term after head trauma associated with autoimmunity. J Neurotrauma 2013; 30: 1426-33
• 32 Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: A systematic review. JAMA 2007; 298: 1429-38
• 33 Herrmann BL, Rehder J, Kahlke S, Wiedemayer H, Doerfler A, Ischebeck W. et al. Hypopituitarism following severe traumatic brain injury. Exp Clin Endocrinol Diabetes 2006; 114: 316-21
• 34 Berg C, Oeffner A, Schumm-Draeger PM, Badorrek F, Brabant G, Gerbert B. et al. Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a german multi-centre screening program. Exp Clin Endocrinol Diabetes 2010; 118: 134-44
• 35 Kopczak A, Kilimann I, von Rosen F, Krewer C, Schneider HJ, Stalla GK. et al. Screening for hypopituitarism in 509 patients with traumatic brain injury or subarachnoid hemorrhage. J Neurotrauma 2014; 31: 99-1077