Research Reports - A five year prospective investigation of anterior pituitary function after traumatic brain injury

J Neurotrauma. 2013 Aug 15;30(16):1426-33

Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA, Bellastella G, Amoresano Paglionico V, Dalla Mora L, Selcuklu A, Unluhizarci K, Casanueva FF, Kelestimur F.

Traumatic brain injury (TBI) has been recently recognized as a common
cause of pituitary dysfunction. However, there are not sufficient numbers of
prospective studies to understand the natural history of TBI induced
hypopituitarism. The aim was to report the results of five years' prospective
follow-up of anterior pituitary function in patients with mild, moderate and
severe TBI. Moreover, we have prospectively investigated the associations between
TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA)
and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women)
were included who were prospectively evaluated 12 months and five years after
TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH)
deficiency is the most common pituitary hormone deficit at one, three, and five
years after TBI. Although most of the pituitary hormone deficiencies improve over
time, there were substantial percentages of pituitary hormone deficiencies at the
fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin
deficiencies). Pituitary dysfunction was significantly higher in strongly AHA-
and APA-positive (titers ≥1/16) patients at the fifth year. In patients with mild
and moderate TBI, ACTH and GH deficiencies may improve over time in a
considerable number of patients but, although rarely, may also worsen over the
five-year period. However in severe TBI, ACTH and GH status of the patients at
the first year evaluation persisted at the fifth year. Therefore, screening
pituitary function after TBI for five years is important, especially in patients
with mild TBI. Moreover, close strong associations between the presence of high
titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the
first time.

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