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hypopituitarism, neuroendocrinology, SAH, TBI
Abstract:
Neuroendocrine disturbances are common after traumatic brain injury
(TBI) and aneurysmal subarachnoid hemorrhage (SAH), but only a few data
exist on long-term anterior pituitary deficiencies after brain injury.
We present data from the Structured Data Assessment of Hypopituitarism
after TBI and SAH, a multi-center study including 1242 patients. We
studied a subgroup of 351 patients, who had sustained a TBI (245) or SAH
(106) at least 1 year before endocrine assessment (range 1-55 years) in
a separate analysis. The highest prevalence of neuroendocrine disorders
was observed 1-2 years post-injury, and it decreased over time only to
show another maximum in the long-term phase in patients with brain
injury occurring >= 5 years prior to assessment. Gonadotropic and
somatotropic insufficiencies were most common. In the subgroup from 1 to
2 years after brain injury (n = 126), gonadotropic insufficiency was the
most common hormonal disturbance (19%, 12/63 men) followed by
somatotropic insufficiency (11.5%, 7/61), corticotropic insufficiency
(9.2%, 11/119), and thyrotropic insufficiency (3.3%, 4/122). In patients
observed >= 5 years after brain injury, the prevalence of somatotropic
insufficiency increased over time to 24.1%, whereas corticotropic and
thyrotrophic insufficiency became less frequent (2.5% and 0%,
respectively). The prevalence differed regarding the diagnostic criteria
(laboratory values vs. physician's diagnosis vs. stimulation tests). Our
data showed that neuroendocrine disturbances are frequent even years
after TBI or SAH, in a cohort of patients who are still on medical
treatment.
