Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2007) 14 P562

ECE2007 Poster Presentations (1) (659 abstracts)

Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury (TBI) in a German multi-centre screening program

Christian Berg 1 , Alexandra Oeffner 4 , Petra Maria Schumm-Draeger 4 , Georg Brabant 2 , B Gerbert 3 , Matthias Weber 5 , Klaus Mann 1 & Burkhard Herrmann 6


1University of Duisburg-Essen, Clinic of Endocrinology, Essen, Germany; 2University of Hannover, Hannover, Germany; 3University of Dresden, Dresden, Germany; 4University of Munich, Klinikum Bogenhausen, Munich, Germany; 5University of Mainz, Mainz, Germany; 6Institute of Cardio-Diabetes, Technology-Centre, Bochum, Germany.


Recent data suggest that hypopituitarism is a common complication of TBI. Prevalence differs between 10–40% and is based on different diagnostic tests and criteria. Hence, under field conditions TBI-mediated hypopituitarism may be less frequent than previously thought. We determined the prevalence of anterior pituitary dysfunction in a multi-centre screening program across five German endocrine centres in patients rehabilitating from TBI (GCS<13).

Patients & methods: 246 patients (43±14 yrs; 133 males, 12±8 months after TBI) underwent baseline endocrine testing with central assessment of TSH, free T4, prolactin, LH, FSH, testosterone (m), estradiol (f), cortisol and IGF-I. If IGF-I was <−1 SDS GHRH+arginine or insulin tolerance test was performed. GHD was defined according to BMI-dependent cut-off values for GH response to GHRH+arginine of <4.2, <8.0 and <11.5 ng/ml in obese, overweight and lean subjects, respectively, and <3 microg/L in ITT. Hypocortisolism was defined when basal cortisol was <200 nmol/l and confirmed by ITT.

Results: In TBI patients some degree of impaired pituitary function was shown in 21% (n=52/246). Total, multiple and isolated deficits were present in 1%, 2% and 18% respectively. 19% (n=46) had an IGF-I of <−1 SDS. In 4% (n=9) GHD was confirmed. IGF-I did not correlate with BMI, gender or time after injury, but with age (P=0.03). 9% (n=23) had hypogonadism (total testosterone <9.5 nmol/L /low estradiol and low gonadotropins). Total testosterone levels did not correlate with BMI or age. 10.7% (n=35) had mild hyperprolactinemia. 4% (n=11) had hypocortisolism and 1% (n=3) had confirmed ACTH-deficiency. 12% (n=29) had TSH-deficiency.

Conclusion: In summary, in this large series carried out on an unselected group of TBI survivors we could not confirm a high prevalence of anterior pituitary dysfunction. Only every fifth patient with low IGF-I had confirmed GHD according to strict criteria and based on BMI-dependent cut-off values for GHRH+arginine testing. Hence IGF-I is a poor predictor for GHD in TBI.

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