Artikel
A prospective longitudinal study on pituitary function after TBI and SAH – Preliminary data from the acute phase in 71 patients
Eine prospektive-longitudinale Studie der Hypophysenfunktionen nach Schädel-Hirn-Trauma oder Subarachnoidalblutung – Endokrinologische Daten aus der akuten Phase bei 71 Patienten
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Veröffentlicht: | 11. April 2007 |
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Objective: Recent data have demonstrated that hypopituitarism seems to be a frequent finding after traumatic brain injury (TBI) and/or subarachnoid hemorrhage (SAH). However, most of these studies referred to retrospective evaluations. There are only a few prospective data, and only two studies which routinely take into account the assessment of the anterior pituitary function in the acute phase after TBI or SAH so far.
Methods: We have prospectively evaluated the anterior pituitary function in 71 patients in the acute phase after TBI (n=35) or SAH (n=36) and a control group of 20 patients with trauma not involving the brain. Endocrine data included basal anterior pituitary lobe hormone, IGF-1 and testosterone serum levels (Immulite 2000) within the first 8 hours after TBI or SAH. Further endocrine evaluation is/has been performed by means of either a combined GHRH-Arginin-CRH-LHRH-Test or an insulin-induced hypoglycemia after 4 months and 12 months. To rule out an assay related bias with regard to GH and IGF-1 all hormone levels were cross checked by a supersensitive assay in another laboratory.
Results: In the acute phase after TBI or SAH 94% of patients demonstrated hormonal abnormalities already. 80% of patients showed pituitary dysfunction involving at least two hormonal axes. Hyperprolactinemia was found in 35% of patients including every second case with a SAH. Irrespective of BMI, 55% of patients demonstrated a pathologically low serum level of age and sex adjusted IGF-1.
Conclusions: Our data suggest a high incidence of endocrine abnormalities after TBI or SAH even within the first 8 hours. Surprisingly we found a high number of patients with pathologically low IGF-1 levels in the acute phase. Our prospective study protocol including the comparison with endocrine findings in trauma patients not involving the brain, repeated measurements utilizing a different assay and the longitudinal follow-up data will substantially add to the data available on this topic thereby potentially clarifying aetiological questions of pituitary dysfunctions after TBI or SAH.