Hypopituitarism following Severe Traumatic Brain Injury

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Abstract
Although hypopituitarism is a known complication of traumatic head injury, it may be under-recognized due to its subtle clinical manifestations. To address this issue, we determine the prevalence of neuroendocrine abnormalities in patients rehabilitating from severe traumatic brain injury (Glasgow Coma Scale ≤ 8). 76 patients (mean age 39 ± 14 yr; range 18 - 65; 53 males and 23 females; BMI 25.8 ± 4.2 kg/m²; mean ± SD) with a severe traumatic brain injury, an average of 22 ± 10 months before this study (median, 20 months), underwent a series of standard endocrine tests, including TSH, free T4, T4, T3, prolactin, testosterone (males), estradiol (females), cortisol, ACTH, GH, and IGF‐I. All subjects also underwent GH response to GHRH + arginine. Growth hormone deficiency (GHD) was defined as a GH response < 9 µg/L to GHRH + arginine and was confirmed by ITT (< 3 µg/L). Pituitary deficiency was shown in 24 % of the patients (18/76). 8 % (n = 6) had GHD (GH-peak range [GHRH + arginine]: 2.8 - 6.3 µg/L; GH-peak range [ITT]: 1.5 - 2.2 µg/L; IGF‐I range: 62 - 174 µg/L). 17 % (n = 13) had hypogonadism (total testosterone < 9.5 nmol/L and low gonadotropins in 12 males; low estradiol, and low gonadotropins in 1 female). Total testosterone levels did not correlate with BMI or age. 2 males with hypogonadism also showed a mild hyperprolactinemia (33 and 41 ng/ml). 3 % (n = 2) patients had partial ACTH-deficiency (cortisol-peak [ITT] 392 and 417 nmol/L) and 3 % (n = 2) had TSH-deficiency. In summary, we have found hypopituitarism in one-fourth of patients with predominantly secondary hypogonadism and GHD. These findings strongly suggest that patients who suffer head trauma must routinely include neuroendocrine evaluations.

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