Research Reports - Predictors of hypopituitarism in patients with traumatic brain injury

J Neurotrauma. 2015 Sep 29. [Epub ahead of print]

Silva PP(1), Bhatnagar S(2), Herman SD(2), Zafonte R(2), Klibanski A(1), Miller
KK(1), Tritos NA(1).

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. 

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