Pituitary insufficiency after traumatic brain injury in southwest Hungary
Orsolya Nemes, Zsuzsanna Nagy, Beata Bodis, Laszlo Bajnok, Dora Szellar, Endre Czeiter, Andras Buki, Tamas Doczi & Emese Mezosi
Traumatic brain injury (TBI) often results in long-term pituitary insufficiency. Regular endocrine screening of TBI patients is advised after the acute phase of the treatment period. We monitored pituitary functions in 32 TBI patients (28 men, 4 women). Endocrine tests were performed from 3 to 36 months after the brain injury. Thyroid functions, cortisol and ACTH levels, prolactin, sex hormone concentrations, GH/IGF1 axis and posterior pituitary function were evaluated. Additional stimulatory tests were done if data indicated pituitary hypofunction: insulin/arginine/glucagone/TRH tests. Mean age of the patients was 35.1 years (men: 35, women: 36). Endocrine abnormalities developed in 37.5% of the patients, 75% of these in one axis and 25% in two axes. Three patients had hyperprolactinemia. Normal endocrine functions were detected in 62.5% of TBI patients. GH deficiency was the most frequently found abnormality in TBI patients (9 cases-28.1%), central hypogonadism was diagnosed in 4 patients (12.5%), and central hypadrenia in 2 (6.25%). Central hypothyroidism and diabetes insipidus were not present in our studied patient group. In conclusion, approximately one third of monitored TBI patients had pituitary dysfunction during follow-up. The majority of these cases displayed single axis disturbance, with GH deficiency representing the leading abnormality. Systematic endocrine follow-up of TBI patients should be extended in Hungary.