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J Clin Endocrinol Metab. 2005 Nov;90(11):6085-92. Epub 2005 Sep 6.

Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study.

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1
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, C.so Dogliotti, 14, 10126 Turin, Italy.

Abstract

CONTEXT:

Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism.

OBJECTIVE:

The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury.

DESIGN AND PATIENTS:

Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32).

RESULTS:

In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency.

CONCLUSION:

There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

PMID:
16144947
DOI:
10.1210/jc.2005-0504
[Indexed for MEDLINE]
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