Endocrine Abstracts (2011) 26 P217

Pituitary gland function following craniocerebral trauma III[deg] in younger patients

R Hampel1, S Ziems1, Ch Zingler2 & A Gabert1

1Internal Medicine Clinic II, Division of Endocrinology and Metabolic Diseases, University of Rostock, Rostock, Germany; 2Institute of Clinical Chemistry and Laboratory Medicine, University of Rostock, Rostock, Germany.

Objects: Based on the recently published literature, the incidence of single- or multi-axis anterior pituitary insufficiency following severe craniocerebral injury was between 33 and 68%. The mean patient age was between 36 and 45 years.

Methods: Using a prospective and standardized protocol, we investigated anterior and posterior pituitary function following craniocerebral injury III° (determined by Glasgow Coma Score) in 35 young patients 14–45 years of age (mean patient age was 25 years). The combined anterior pituitary function test (CRH, TRH, GnRH, GHRH–arginine) as well as measurement of plasma and urine osmolality was performed no earlier than 3 months following the craniocerebral injury (19.8 months on average).

Results: We found isolated ACTH, GH and FSH/LH secretion insufficiency in 8.7, 5.7 and 5.7% of cases respectively (cumulative percentage = 20.1%). Combined adrenocorticotropic and somatotropic axis insufficiency was observed in 2.9% of cases. Thyreotropic and lactotropic function remained intact. No diabetes insipidus. The prevalence of axis insufficiency correlated with the age at the time of craniocerebral injury (age <20 years 18%, 20–45 years 25%, age <30 years 20%, 30–45 years 27%).

Conclusions: The relatively high prevalence of anterior pituitary insufficiency after severe craniocerebral trauma reported in the literature applies to older patients. These results must be treated with caution since few authors have used suitable and standardized methods for measuring anterior pituitary function.

Anterior pituitary insufficiency following craniocerebral trauma III° is only rarely observed in younger patients. Since adrenocorticotropic insufficiency had the highest incident rate, we consider the testing of adrenocorticotropic function during follow-up after craniocerebral trauma III° as being of particular importance.

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