Prospective evaluation of traumatic brain injury mediated hypopituitarism 1 year after the event
Jacinta Santos1, Miguel Carvalho2, Isabel Paiva1, Carla Baptista1, Carlos Ferro2, Alexandra Vieira1, Márcia Alves1, Sofia Gouveia1 & Manuela Carvalheiro1
Introduction: Traumatic brain injury (TBI) is considered a rare cause of pituitary dysfunction. Recently, some retrospective studies demonstrated that TBI-mediated hypopituitarism is more frequent than previously known. However, its prevalence and natural history are still unclear.
Objectives: To evaluate the prevalence of hypopituitarism 1 year after TBI and the association between the seriousness of the traumatism and the pituitary deficits.
Patients and methods: Twenty-two patients (64% male, 45.9±25.8 years; 36% female; 68.4±18.9 years) with TBI, but without previous pituitary dysfunction were included. Clinical and hormonal evaluations were performed 1 year after the traumatic event.
Results: Types of traumatism: subdural haematoma (twelve), brain contusion (eight), brain haematoma (three) and bone fracture (three). The causes of traumatism were: falls (59.1%), traffic accidents (22.7%), sportive accidents (9.1%) and working accidents (9.1%). In what concerns to the seriousness, evaluated through the Glasgow Scale, 72.7% were mild traumatisms, 18.2% moderate and 9.1% severe. A total of 31.8% of the patients were submitted to surgery. One year after the event, on clinical evaluation: asymptomatic (45.5%), headaches (9.1%), amnesia (18.2%), VI pair paralysis (4.5%) and disartria (4.5%). No patient presented diabetes insipidus. Endocrine evaluation: TSH 1.68±0.97 (0.44.0 μUI/ml), fT4 1.3±0.19 (0.81.9 ng/dl), PRL 6.32±3.56 ng/ml (<20), ACTH 24.44±15.55 pg/ml (952), cortisol 11.59±4.07 μg/dl (525) and GH 1.51±1.51 ng/ml (<4). Through the quantification of IGF-I, according to the age group, 31.8% presented deficiency.
Conclusions: GH deficiency, the most frequent endocrine consequence of TBI, according to the literature, was the only pituitary insufficiency diagnosed. There wasnt a relation between the seriousness of the traumatism and the endocrine consequences, since six of these patients suffered a mild TBI and one had a severe TBI. Considering the short period of time between the traumatism and the evaluation, its essential to follow these patients, in order to diagnose and treat precociously any pituitary insufficiency.