Introduction: Recent studies have found hypopituitarism (HP) to be a common complication of traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH). In Iceland most patients with moderate TBI and all patients with severe TBI and SAH are transferred to Landspitali University Hospital (LSH). The aim of this study was to assess the prevalence of HP following TBI/SAH in Iceland, 3 and 12 months after the incidence.
Methods: All adult patients with moderate and severe TBI and SAH transmitted to LSH through one year were included, a total of 40 patients. Four patients died shortly after admission. Twenty-four patients accepted participation 3 months after TBI/SAH, 12 and 12 patients respectively. Twenty-five patients were screened 12 months after TBI/SAH, 14 and 11 patients respectively. Baseline hormone levels were measured and an insulin tolerance test (ITT) was performed. If ITT was contraindicated a Synachten test and a GHRH-arginine test were performed.
Results: Three months after TBI/SAH, 7 of the 24 patients (29.2%) had HP, 4 TBI patients (33.3%) and 3 SAH patients (25%). Two had (GHD), confirmed with GHRH-arginine test. One had elevated prolactin level. Two premenopausal women had oligomenorrhea. Three men had low testosterone and inappropiately low gonadotropin levels, one of them also had GHD. Twelve months after TBI/SAH, 6 of the 25 patients (24%) had HP, 5 TBI patients (35.7%) and 1 SAH patient. Three patients had GHD confirmed with GHRH-argine test (1 SAH patient). Two men had low testosterone and inappropiately low gonadotropin levels. One patient had mildly raised prolactin levels.
Conclusion: HP was confirmed in 29.2% and 24% of patients after 3 and 12 months respectively. Interestingly none of the GHD patients were diagnosed using the ITT. These results do emphasize the need for screening of pituitary function after TBI and SAH.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.
05 - 09 May 2012
European Society of Endocrinology