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Prevalence and predictive factors of post‐traumatic hypopituitarism
Author(s) -
Klose M.,
Juul A.,
Poulsgaard L.,
Kosteljanetz M.,
Brennum J.,
FeldtRasmussen U.
Publication year - 2007
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2007.02860.x
Subject(s) - medicine , hypopituitarism , traumatic brain injury , glasgow coma scale , insulin tolerance test , body mass index , odds ratio , diabetes insipidus , overweight , cohort , confidence interval , endocrinology , pediatrics , gastroenterology , obesity , surgery , insulin resistance , insulin sensitivity , psychiatry
Summary Objective To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI). Design A cross‐sectional cohort study. Patients One hundred and four hospitalized TBI patients (26F/78M), median age 41 (range 18–64) years, body mass index (BMI) 25 (17–39) kg/m 2 ; severity: mild [Glasgow Coma Scale (GCS) score 13–15) n = 44, moderate (GCS 9–12) n = 20, severe (GCS < 9) n = 40]. Measurements Patients were evaluated 13 (10–27) months post‐injury, with measurement of baseline (0800–1000 h) and post‐stimulatory hormonal levels during an insulin tolerance test (ITT) (86%) or, if contraindicated, an arginine(arg)‐GHRH test + Synacthen test (14%). Insufficiencies were confirmed by retesting. Results Hypopituitarism was found in 16 (15%) patients, affecting one axis in 10, two axes in four and more than two axes in two patients. The GH axis was most frequently affected (15%), followed by secondary hypoadrenalism (5%), hypogonadism (2%), hypothyroidism (2%) and diabetes insipidus (2%). The risk of pituitary insufficiency was increased in patients with severe TBI as opposed to mild TBI [odds ratio (OR) 10·1, 95% confidence interval (CI) 2·1–48·4, P = 0·004], and in those patients with increased intracerebral pressure [OR 6·5, 95% CI 1·0–42·2, P = 0·03]. Patients with only one affected axis were all GH deficient; 60% ( n = 6) of these were overweight or obese. Conclusion The prevalence of hypopituitarism was estimated at 16%. Although high, this value was lower than previously reported, and may still be overestimated because of well‐known confounding factors, such as obesity. Indicators of increased TBI severity were predictive of hypopituitarism, with a high negative predictive value. Neuroendocrine evaluation should therefore be considered in patients with severe TBI, and in particular in those with increased intracerebral pressure (ICP).