gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Neuroendocrine dysfunction following traumatic brain injury: a prospective longitudinal study

Neuroendokrine Funktionsstörungen nach Schädel-Hirn-Trauma: Ergebnisse einer prospektiven longitudinalen Studie

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  • corresponding author A. Kleindienst - Neurochirurgische Klinik, Universitätsklinikum Göttingen
  • A. Filis - Neurochirurgische Klinik, Universitätsklinikum Göttingen
  • C. Bock - Neurochirurgische Klinik, Universitätsklinikum Göttingen
  • P. Valbuena - Neurochirurgische Klinik, Universitätsklinikum Göttingen
  • M. Buchfelder - Neurochirurgische Klinik, Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSO.04.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc185.shtml

Published: May 8, 2006

© 2006 Kleindienst et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: While neuroendocrine dysfunction at some time point following traumatic brain injury (TBI) has been described in a large number of studies in recent years, there is a lack of longitudinal studies comparing initial laboratory findings of pituitary hormones in the acute period with the results of functional testing of the hypothalamic-pituitary insufficiency more than a year post-injury. The present study was designed to fill this gap.

Methods: In 82 consecutive patients admitted for TBI, the cortico-, thyreo-, gonado- and somatotropic as well as the posterior pituitary function were examined on day 0, 3 and 7 post-injury. To date, in 14 patients dynamic endocrine testing 30-36 months after the trauma is available. Recovery was assessed by the Glasgow Outcome Scale (GOS) at 6 months and by the Nottingham Health Profile at 30-36 months. Consent from the ethical committee was obtained.

Results: Age ranged from 18-92 years (mean 52) and trauma severity was mild to severe (initial Glasgow Coma Score, GCS, 3 to 15). In the acute post-trauma period, most of the patients suffered from hypothalamo-pituitary dysfunction (25% cortico-, 46% thyreo-, 83% gonado- and/or 23% somatotropic system), while at the last follow-up one third of patients demonstrated clinical findings suggestive of hypopituitarism. Dynamic testing of the corticotropic system by an ACTH-test revealed an insufficient increase in all patients (compared to age-matched controls). Growth hormone (GH) deficiency as examined by the GHRH-Arginine test was found in 50%. One patient had an absolute loss of growth hormone secretion (increment <3ng/ml). However, no significant association of GCS or GOS and pituitary dysfunction was established.

Conclusions: The prevalence of hypopituitarism may be as high as 80% early after TBI with some 50% persistent endocrine insufficiency for years, altogether suggesting an alarming socio-economic impact. Since none of our patients had been offered hormonal replacement therapy, we conclude that a substantial percentage of these patients remain undiagnosed and untreated.