Results of French collaborative evaluation (DEPHY-TC) in patients with suspected pituitary abnormalities after traumatic brain injury (TBI)
S Courtois1, M L Nunes2, M F Malezet3, N Morlet-Barla4, F Borson-Chazot1, P Peruzzi3, A Tabarin2, M Delarque4, S Ciancia1, F Boyer3, E Cuny2, A Delarque4, B Delemer3, E Richer2, H Curallucci5, L Di Nicola6 & G Raverot1
Study aim: Pituitary function evaluation in patients with traumatic brain injury (TBI).
Subjects: One hundred and forty-six patients (49 female, 97 men, age: 31.9±16.2 years) recovered from moderate to severe TBI. Prospective follow up has been performed 3/6 and 12 months from TBI for 79 subjects. Retrospective evaluation (from 0.3 to 30 years) included 67 subjects selected in front of overt clinical features (obesity, fatigue, sexual disorders).
Methods: Clinical (neurological, endocrine, and general) and hormonal evaluations were performed using a standardized protocol including determination of FT4, TSH, PRL, IGF1, testosterone/E2, FSH and LH. Corticotrope and somatotrope axes were evaluated using glucagon-, insulin tolerance- or GHRH-arginine tests.
Results: Prospective group. 36 months after TBI (n=79): 44.3% presented endocrine dysfunction: GH deficiency (GHD) (22%) gonadotrope deficiency (19%), corticotrope deficiency (13%), thyrotrope deficiency (5%). Twelve months after TBI (n=46) 34.8% presented endocrine dysfunction: GH deficiency (GHD) (15%) gonadotrope deficiency (24%), corticotrope deficiency (2%), thyrotrope deficiency (2%).
Combined deficiency was observed in 12.6 and 6.5% of cases initially and after 12 months respectively.
Six of nine patients with GHD at first evaluation recovered normal somatotrope function after 12 months but three new patients with GHD were diagnosed at this time.
Retrospective group (n=67) 45.3% subjects presented endocrine dysfunction: GHD (32.8%), gonadotrope deficiency (17.1%), corticotrope deficiency (9.3%), thyrotrope deficiency (4.7%). Combined deficiency was observed in 17.1% of cases.
Among patients with a follow-up after TBI >1 year (n=99), GHD patients (n=25) presented significant increase of body mass index (P<0.05) compare to GH sufficient patients (n=74).
Conclusion: Our data in the prospective cohort confirm that pituitary dysfunction after TBI may evolve over time and requires multiple evaluations. Prospective interventions studies are needed to evaluate the benefits of hormonal supplementation in these patients.