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- Title
Prevalence and predictive factors of post-traumatic hypopituitarism.
- Authors
Klose, Marianne Christina; Juul, A.; Poulsgaard, L.; Kosteljanetz, M.; Brennum, J.; Feldt-Rasmussen, U.
- Abstract
Objective To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI). Design A cross-sectional cohort study. Patients One hundred and four hospitalized TBI patients (26F/78M), median age 41 (range 18–64) years, body mass index (BMI) 25 (17–39) kg/m2; severity: mild [Glasgow Coma Scale (GCS) score 13–15) n = 44, moderate (GCS 9–12) n = 20, severe (GCS < 9) n = 40]. Measurements Patients were evaluated 13 (10–27) months post-injury, with measurement of baseline (0800–1000 h) and post-stimulatory hormonal levels during an insulin tolerance test (ITT) (86%) or, if contraindicated, an arginine(arg)-GHRH test + Synacthen test (14%). Insufficiencies were confirmed by retesting. Results Hypopituitarism was found in 16 (15%) patients, affecting one axis in 10, two axes in four and more than two axes in two patients. The GH axis was most frequently affected (15%), followed by secondary hypoadrenalism (5%), hypogonadism (2%), hypothyroidism (2%) and diabetes insipidus (2%). The risk of pituitary insufficiency was increased in patients with severe TBI as opposed to mild TBI [odds ratio (OR) 10·1, 95% confidence interval (CI) 2·1–48·4, P = 0·004], and in those patients with increased intracerebral pressure [OR 6·5, 95% CI 1·0–42·2, P = 0·03]. Patients with only one affected axis were all GH deficient; 60% ( n = 6) of these were overweight or obese. Conclusion The prevalence of hypopituitarism was estimated at 16%. Although high, this value was lower than previously reported, and may still be overestimated because of well-known confounding factors, such as obesity. Indicators of increased TBI severity were predictive of hypopituitarism, with a high negative predictive value. Neuroendocrine evaluation should therefore be considered in patients with severe TBI, and in particular in those with increased intracerebral pressure (ICP).
- Subjects
DENMARK; BRAIN injuries; PITUITARY necrosis; PUERPERAL disorders; COHORT analysis; ENDOCRINE diseases
- Publication
Clinical Endocrinology, 2007, Vol 67, Issue 2, p193
- ISSN
0300-0664
- Publication type
Article
- DOI
10.1111/j.1365-2265.2007.02860.x