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.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology