Research Reports - Screening for hypopituitarism in 509 patients with traumatic brain injury

J Neurotrauma. 2013 Aug 27

Kopczak A, Kilimann I, von Rosen F, Krewer C, Schneider HJ, Stalla GK, Schneider M

We performed a screening on patients with traumatic brain injury (TBI) and
subarachnoid hemorrhage (SAH) to determine the prevalence of posttraumatic
hypopituitarism in neurorehabilitation in a cross-sectional, observational
single-center study. In addition, the therapeutic consequences of our screening
were analyzed retrospectively. From February 2006 to August 2009, patients
between 18 and 65 years (n=509) with the diagnosis of TBI (n=340) or SAH (n=169)
were screened within two weeks of admittance to neurorehabilitation as clinical
routine. Blood was drawn to determine fasting cortisol, fT4, prolactin,
testosterone or estradiol and IGF-I. Patients with abnormalities in the screening
or clinical signs of hypopituitarism received further stimulation tests, e.g.
GHRH-L-arginine-test and ACTH-test (n=36), ACTH-test alone (n=26) or insulin
tolerance test (n=56). In our screening of 509 patients, 28.5% showed lowered
values in at least one hormone of the hypothalamus-pituitary axis, 4.5% in two or
more axes. The most common disturbance was a decrease of testosterone in 40.7% of
all men (in the following 13/131 men were substituted). Low fT4 was detected in
5.9% (n=3 substituted), low IGF-I in 5.8%, low cortisol in 1.4%, and low
prolactin in 0.2% (none substituted, respectively). Further stimulation tests
revealed growth hormone deficiency in 20.7% (n=19/92) and hypocortisolism in
23.7% (n=28/118), respectively. Laboratory values possibly indicating
hypopituitarism (33%) were very common but did not always implicate posttraumatic
hypopituitarism. Based on the screening program only 13 patients (3%) were
clinically diagnosed as pituitary insufficient and received hormone replacement
therapy.

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