Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury

• Published in: Clinical endocrinology (Oxford) Vol. 61; no. 3; pp. 320 - 326
• Main Authors: Aimaretti, Gianluca, Ambrosio, Maria Rosaria, Di Somma, Carolina, Fusco, Alessandra, Cannavò, Salvatore, Gasperi, Maurizio, Scaroni, Carla, De Marinis, Laura, Benvenga, Salvatore, Uberti, Ettore Carlo degli, Lombardi, Gaetano, Mantero, Franco, Martino, Enio, Giordano, Giulio, Ghigo, Ezio
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.09.2004; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Arginine; Biological and medical sciences; Brain Injuries - blood; Brain Injuries - complications; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Growth Hormone - blood; Growth Hormone-Releasing Hormone; Humans; Hypopituitarism - blood; Hypopituitarism - diagnosis; Hypopituitarism - etiology; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-Like Growth Factor I - analysis; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary Gland - physiopathology; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - complications; Time Factors; Vertebrates: endocrinology; Endocrinopathy; High risk; Nervous system diseases; Subarachnoid hemorrhage; Cardiovascular disease; Medical screening; Trauma; Cerebral disorder; Vascular disease; Hypophyseal insufficiency; Cerebral hemorrhage; Pituitary diseases; Central nervous system disease; Cerebrovascular disease; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2004.02094.x

Summary objective  Acquired hypopituitarism in adults is obviously suspected in patients with primary hypothalamic–pituitary diseases, particularly after neurosurgery and/or radiotherapy. That brain injuries (BI) can cause hypopituitarism is commonly stated and has been recently emphasized but the management of BI patients does not routinely include neuroendocrine evaluations. aim  To clarify the occurrence of hypopituitarism in patients after traumatic brain injury (TBI) or subarachnoid haemorrhage (SAH) 3 months after the BI. subjects and methods  The occurrence of hypopituitarism in conscious patients after traumatic brain injury [TBI, n = 100, 31 women, 69 men; age 37·1 ± 1·8 years; body mass index (BMI) 23·7 ± 0·4 kg/m2; Glasgow Coma Scale (GCS) 3–15] or subarachnoid haemorrhage [SAH, n = 40, 14 men, 26 wpmen, 51·0 ± 2·0 years; 25·0 ± 0·6 kg/m2; Fisher's scale 1–4] was studied in a multicentre study 3 months after the BI. All patients underwent wide basal hormonal evaluation; the GH/IGF‐I axis was evaluated by GHRH + arginine test and IGF‐I measurement. results  In TBI patients, some degree of hypopituitarism was shown in 35%. Total, multiple and isolated deficits were present in 4, 6 and 25%, respectively. Diabetes insipidus was present in 4%. Secondary adrenal, thyroid and gonadal deficit was present in 8, 5 and 17%, respectively. Severe GH deficiency (GHD) was the most frequent pituitary defect (25%). In SAH patients, some degree of hypopituitarism was shown in 37·5%. Despite no total hypopituitarism, multiple and isolated deficits were present in 10 and 27·5%, respectively. Diabetes insipidus was present in 7·5%. Secondary adrenal, thyroid and gonadal deficit was present in 2·5, 7·5 and 12·5%, respectively. Severe GHD was the most frequent defect (25%). conclusions  TBI and SAH are conditions associated with high risk of acquired hypopituitarism. The pituitary defect is often multiple and severe GHD is the most frequent defect. Thus neuroendocrine evaluations are always mandatory in patients after brain injuries.