gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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

Meeting Abstract

  • corresponding author J. Kreutzer - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen
  • M. Bidlingmaier - Medizinische Klinik, Klinikum Innenstadt der Universität München, München
  • A. Olk - Abteilung für Unfall- und Orthopädische Chirurgie, Chirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg, Erlangen
  • F. Hennig - Abteilung für Unfall- und Orthopädische Chirurgie, Chirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg, Erlangen
  • C. Nimsky - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen
  • M. Buchfelder - Klinik für Neurochirurgie, Klinikum der Universität Erlangen-Nürnberg, Erlangen

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.06.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc100.shtml

Published: April 11, 2007

© 2007 Kreutzer et al.
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Outline

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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.