Evaluation of anterior pituitary function following traumatic brain injury

Abstract

Introduction: Neuroendocrine dysfunction following traumatic brain injury (TBI) is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI. Materials and Methods: From June to December 2009, overaperiod of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, (61 males and 9 females mean age 30 years) included in the study, 39 patients had moderate (GCS; 9-12) and 31 cases had severe (GCS < 8) TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status. Results: Forty-one patients (58.6%) were found to be suffereding from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins (LH, FSH), 12.9%, corticotropin (ACTH), 12.9%, somatotropin (GH), 4.3%, and prolactin (PRL), 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases (31.5%). Conclusion: The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patients' health.