Artikel
Hypopituitarism following traumatic brain injury – short- and long-term results
Hypophysäre Insuffizienz nach Schädel-Hirn-Verletzungen – Kurz- und Langzeitergebnisse
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Veröffentlicht: | 30. Mai 2008 |
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Objective: Recent data have suggested that significant pituitary dysfunction following traumatic brain injury is common. The pathomechanism leading to these dysfunction is not known. The aim of this study was to investigate the incidence and kind of pituitary dysfunction following traumatic brain injury after a longer time interval.
Methods: A total of 52 patients (30 male, 22 female, mean age 50.8, age range 16–88 years) were included. The patients were investigated 1 and 5 years following TBI. Basal hormone values and dynamic testing of pituitary function was performed using combined anterior pituitary test and glucose tolerance test. The results were correlated to data on the mechanism and magnitude of the accident and the subsequent trauma sequels.
Results: In 58% of the patients, the dysfunction of at least one hormone axis could be demonstrated. In 12% a combination of deficiencies for 2 or 3 axes could be found. The incidence of deficiencies of the gonadotropines and of prolactine was significantly lower when compared to the growth hormone, TSH and ACTH/Cortisol axes. There were no significant differences between the incidences 1 and 5 years following TBI. In multivariate analysis, CSF fistula, skull base fracture, GCS score, increased ICP and contusions could not be identified as risk factors for posttraumatic pituitary dysfunction.
Conclusions: In conclusion we found that more than 50% of the patients develop persistent pituitary dysfunction 1 and 5 years following TBI. The growth hormone and ACTH/Cortisol axes were significantly more affected. The functional testing using overlapping tests seems to increase sensitivity for the detection of pituitary dysfunction. It should be performed in all patients 1 year following TBI.