Objective: Hypopituitarism in adults may be a consequence of TBI, but in the acute or long term management of TBI patients (ptx), endocrine evaluations are not usually included. Aim of this study was to investigate the prevalence of hypopituitarism and metabolic syndrome in a population of 54 severe (n=31) and moderate (n=23) TBI ptx (38 M, 16 F; age (mean±S.D.): 39.8±2.1 years) who had TBI more than 12 months before.
Subjects and methods: The ptx were studied in a multidisciplinary team with rehabilitation doctors, neurologists and endocrinologists. The whole ptx population underwent: (1) a basal evaluation of the hypothalamicpituitary unit; (2) the dynamic evaluation of the GH/IGF-I axis through the GHRH+Arginine test; (3) blood glucose/insuline levels (HOMA index), and lipid profile; (4) anthropometric evaluations.
Results: The 27.7% ptx showed various degrees of hypopituitarism. In particular, 9.25% had total, 7.4% multiple and 9.25% isolated hypopituitarism. Severe GH deficiency was present in 22.2% ptx, secondary hypogonadism, hypothyroidism, hypocortisolism and diabetes insipidus was present in 16.6, 12.9, 12.9 and 5.5%, respectively. In non-hypopituitaric ptx (39/54), features of the metabolic syndrome were present as visceral obesity in 35.8% ptx, dyslipidemia in 10.2% ptx, hypertension in 7.6% ptx and impairment in glucose/insulin metabolism in 33.3% ptx. If we consider only hypopituitaric ptx (15/54), features of the metabolic syndrome were present as visceral obesity in 60% ptx, dyslipidemia in 40% ptx, hypertension in 13.3% ptx and impairment in glucose/insulin metabolism in 33.3% ptx. In all, 5/54 ptx had metabolic syndrome and 4/5 were hypopituitaric.
Conclusions: Hypopituitarism and features of the metabolic syndrome are commonly diagnosed in TBI ptx. Hypopituitarism per se worsen the metabolic condition of TBI ptx, suggesting particular care of these clinical aspects in the rehabilitation period after severe or moderate TBI.