gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

A prospective longitudinal study on pituitary function in the acute, subacute and chronic phase after traumatic brain injury or subarachnoid haemorrhage

Meeting Abstract

  • J. Kreutzer - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • A. Kleindienst - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • H. Akutsu - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • M. Bidlingmaier - Medizinische Klinik, Klinikum Innenstadt, LMU München
  • C. Schoefl - Neurochirurgische Klinik, Abteilung Neuroendokrinologie, Universität Erlangen-Nürnberg
  • M. Buchfelder - Neurochirurgische Klinik, Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.03-08

DOI: 10.3205/09dgnc017, URN: urn:nbn:de:0183-09dgnc0170

Veröffentlicht: 20. Mai 2009

© 2009 Kreutzer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Recent studies report a high rate of pituitary deficiency after traumatic brain injury (TBI) or subarachnoid haemorrhage (SAH). However, the reported prevalences are heterogeneous. This prospective longitudinal study was conducted to assess pituitary dysregulation after TBI or SAH using induced hypoglycaemia (ITT) as the gold standard in testing the hypothalamo-pituitary axis whenever possible.

Methods: We have prospectively evaluated the anterior pituitary function in 164, 58, and 40 consecutive patients in the acute, subacute, and chronic phase after TBI or SAH. ITT was performed in 43 and in 15 patients after 3 months, followed by 29 (ITT) and 11 (GHRH-arginine-CRH-LHRH-Test) after 12 months. GH deficiency was defined as GH <3.0 ng/ml (ITT) or BMI adapted (GHRH-arginine). Corticotropic deficiency was defined as stimulated peak cortisol <18.1 µg/dl. Male hypopituitarism was defined as testosterone levels <2.31 ng/ml.

Results: The overall rate of GH-deficiency after 3 and 12 months was 15.8% and 17.5%, respectively. However, GH-deficiency according to the ITT was 0% at both time points. Male hypogonadism was found in 6.7% (3 months) and 0% (12 months). The prevalence of adrenocorticotropic insufficiency was 10.5% (3 months) and 5% (12 months). Acute hyperprolactinaemia occurred in 43.5 % of the patients with SAH compared to only 31.9% with TBI. The rate of hyperprolactinaemia in SAH was correlated to the Hunt & Hess severity score.

Conclusions: Our data suggest a high correlation between the prevalence of somatotropic and corticotropic insufficiency in patients after TBI or SAH and the chosen dynamic endocrine test. The discrepancy between the rates of GH deficiency using the ITT in comparison to the GHRH-arginine test suggests that the latter may not be adequate to evaluate the hypothalamo-pituitary axis in patients after TBI or SAH. The high rate of acute hyperprolactinaemia in severe SAH may be related to disturbances of the pituitary stalk caused by blood clots in the basal cisterns.