Endocrine Abstracts (2008) 16 OC1.1

Structured assessment of neuroendocrine dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage in 921 patients: the German Interdisciplinary Database

Harald Schneider, Manfred Schneider, U Tuschy, Henri Wallschofski, Michael Faust, C Renner, Anna Kopchak, Martina Jordan, Bernhard Saller, Friedrich von Rosen, Ilonka Kreitschmann-Andermahr, Michael Buchfelder & Günter Karl Stalla

Max Planck Institute of Psychiatry, Munich, Germany.

Background: Recent studies show that traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) are frequent causes of long-term disturbances of hypothalamo–pituitary function. Still little is known about risk factors and clinical characteristics of pituitary impairment after brain damage. This study aimed to address these questions on a larger scale by establishing a national registry of these patients.

Methods: All centers treating patients with TBI or SAH and performing endocrine assessments can include patients. Data were collected using a structured, internet-based study sheet, obtaining information on clinical, radiological and hormonal parameters.

Results: To date, 921 patients (594 TBI, age 43.5±19.7 years; 324 SAH, 49.7±11.8 years) have been included. Stimulation tests for the corticotropic and somatotropic axes were performed in 241 (26%) and 206 (22%) patients, respectively. Information of pituitary function was still lacking in many patients. In patients with known pituitary function, hypopituitarism was reported in 44 and 29% after TBI and SAH, respectively. When we considered only patients with at least one stimulation test for the corticotropic and somatotropic axes, the frequencies of hypopituitarism after TBI and SAH were 52 and 65%, respectively. According to the frequency of impariment, pituitary hormone secretion was impaired the following sequence: ACTH, GH, LH/FSH, and TSH.

Conclusions: Our data confirm that hypopituitarism is a common complication of TBI and SAH. We cannot exclude a certain selection bias for performing endocrine stimulation tests only in more severely affected subjects. Nevertheless, the fact that pituitary impairments are remarkably more common in patients with than without endocrine stimulation tests implies that hypopituitarism might be overlooked if only basal values are performed.