Is there an endocrine explanation for persistent neuropsychological disabilities long after traumatic brain injury (TBI)?
Edwige Yollin1, Odile Kozlowski2, Benoît Soudan3, Michèle DHerbomez4, Pierre Fontaine1, Marc Rousseaux4 & Christine Cortet-Rudelli1
The aims of this study were to determine the prevalence of pituitary dysfunction in patients keeping neuropsychological disabilities long after TBI (at least 1 year), to research predictive factors and to evaluate consequences of endocrine abnormalities on metabolism and quality of life in these patients.
We studied 50 patients (42 men, mean age 36, range 2059 years, mean BMI 25, range 1742 kg/m2) who had survived severe (n=38), moderate (n=2) or mild TBI (n=10) at a mean of 59 months (range 13247) post event. 52% had moderate, 32% had severe disability (GOS score: 2 or 3 respectively), 30% had anosognosia.
No patient showed posterior pituitary dysfunction, hyperprolactinemia or gonadotropin deficiency. Six patients (12%) showed TSH deficiency. Ten patients (20%) had partial ACTH deficiency (diagnosed by ITT or metyrapone test). Severe GH deficiency was diagnosed in 44.5% (glucagon stimulation test confirmed by ITT or arginine+GHRH test) and was isolated in 40% of cases. GHD patients had significantly higher BMI, triglycerid, fasting and postprandial insulin plasma levels than no-GHD patients, but mean QoL-AGHDA or NHP questionnaires scores were not significantly different in the 2 groups even among non-anosognosic patients. Totally 46% of the patients showed at least one anterior pituitary deficiency requiring a substitutive treatment (multiple and isolated hormone deficiency in 24% and 22% respectively). Hypopituitarism was not related to GCS score, initial CT scan lesions, GOS score, self-sufficiency (EBIS scale score) or resumption of work.
The high risk for anterior pituitary deficiency in patients with persistent neuropsychological disabilities long after TBI justify a pituitary exploration in all of them, with reference tests, even long after the TBI. Evaluation of quality of life must be adjusted to TBI patients, with specialised neuropsychological testing and multidisciplinary collaboration.