Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a German multi-centre screening program.
dc.contributor.author | Berg, C | |
dc.contributor.author | Oeffner, A | |
dc.contributor.author | Schumm-Draeger, P-M | |
dc.contributor.author | Badorrek, F | |
dc.contributor.author | Brabant, Georg E | |
dc.contributor.author | Gerbert, B | |
dc.contributor.author | Bornstein, S | |
dc.contributor.author | Zimmermann, A | |
dc.contributor.author | Weber, M | |
dc.contributor.author | Broecker-Preuss, M | |
dc.contributor.author | Mann, K | |
dc.contributor.author | Herrmann, B L | |
dc.date.accessioned | 2010-08-04T14:00:32Z | |
dc.date.available | 2010-08-04T14:00:32Z | |
dc.date.issued | 2010-02 | |
dc.identifier.citation | Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a German multi-centre screening program. 2010, 118 (2):139-44 Exp Clin Endocrinol Diabetes | en |
dc.identifier.issn | 1439-3646 | |
dc.identifier.pmid | 19691014 | |
dc.identifier.doi | 10.1055/s-0029-1225611 | |
dc.identifier.uri | http://hdl.handle.net/10541/109060 | |
dc.description.abstract | INTRODUCTION: We determined the prevalence of anterior pituitary dysfunction in a multi-centre screening program across five German endocrine centres in patients rehabilitating from TBI (GCS<13). PATIENTS & METHODS: 246 patients (39+/-14 yrs; 133 males, 12+/-8 months after TBI) underwent a series of baseline endocrine tests with central assessment of TSH, free T4, prolactin, LH, FSH, testosterone (m), estradiol (f), cortisol, GH, and IGF-I. If IGF-I was <-2 SDS dynamic testing was performed. GHD was defined according to BMI-dependent cut-off values for GH response to GHRH+arginine of <4.2, <8.0 and <11.5 ng/ml in obese, overweight and lean subjects, respectively, or <3 micro g/l in ITT. Hypocortisolism was suggested when basal cortisol was <200 nmol/l and confirmed by ITT (peak<500 nmol/l). RESULTS: In TBI patients some degree of impaired pituitary function was shown in 21% (n=52/246). Total, multiple and isolated deficits were present in 1%, 2% and 18%, respectively. 19% had an IGF-I of <-1 SDS, 9% of <-2 SDS. In 5% GHD was confirmed. 9% had hypogonadism. 4% had hypocortisolism and 1% of patients had confirmed ACTH-deficiency. 12% had TSH-deficiency. SUMMARY: In summary, in this large series carried out on an unselected group of TBI survivors we have found hypopituitarism in every fifth patient with predominantly secondary hypogonadism and hypothyreosis. Regarding somatotrope insufficiency IGF-I is decreased in 50% of GHD patients. CONCLUSION: These findings strongly suggest that patients who suffer head trauma should routinely undergo endocrine evaluation. | |
dc.language.iso | en | en |
dc.subject.mesh | Adult | |
dc.subject.mesh | Aged | |
dc.subject.mesh | Aged, 80 and over | |
dc.subject.mesh | Brain Injuries | |
dc.subject.mesh | Chemiluminescent Measurements | |
dc.subject.mesh | Estradiol | |
dc.subject.mesh | Female | |
dc.subject.mesh | Germany | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Hydrocortisone | |
dc.subject.mesh | Insulin-Like Growth Factor I | |
dc.subject.mesh | Male | |
dc.subject.mesh | Middle Aged | |
dc.subject.mesh | Pituitary Diseases | |
dc.subject.mesh | Pituitary Hormones, Anterior | |
dc.subject.mesh | Prevalence | |
dc.subject.mesh | Testosterone | |
dc.title | Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a German multi-centre screening program. | en |
dc.type | Article | en |
dc.contributor.department | Clinic of Endocrinology, University Hospital of Essen, Germany. christian.berg@uni-essen.de | en |
dc.identifier.journal | Experimental and Clinical Endocrinology & Diabetes | en |
html.description.abstract | INTRODUCTION: We determined the prevalence of anterior pituitary dysfunction in a multi-centre screening program across five German endocrine centres in patients rehabilitating from TBI (GCS<13). PATIENTS & METHODS: 246 patients (39+/-14 yrs; 133 males, 12+/-8 months after TBI) underwent a series of baseline endocrine tests with central assessment of TSH, free T4, prolactin, LH, FSH, testosterone (m), estradiol (f), cortisol, GH, and IGF-I. If IGF-I was <-2 SDS dynamic testing was performed. GHD was defined according to BMI-dependent cut-off values for GH response to GHRH+arginine of <4.2, <8.0 and <11.5 ng/ml in obese, overweight and lean subjects, respectively, or <3 micro g/l in ITT. Hypocortisolism was suggested when basal cortisol was <200 nmol/l and confirmed by ITT (peak<500 nmol/l). RESULTS: In TBI patients some degree of impaired pituitary function was shown in 21% (n=52/246). Total, multiple and isolated deficits were present in 1%, 2% and 18%, respectively. 19% had an IGF-I of <-1 SDS, 9% of <-2 SDS. In 5% GHD was confirmed. 9% had hypogonadism. 4% had hypocortisolism and 1% of patients had confirmed ACTH-deficiency. 12% had TSH-deficiency. SUMMARY: In summary, in this large series carried out on an unselected group of TBI survivors we have found hypopituitarism in every fifth patient with predominantly secondary hypogonadism and hypothyreosis. Regarding somatotrope insufficiency IGF-I is decreased in 50% of GHD patients. CONCLUSION: These findings strongly suggest that patients who suffer head trauma should routinely undergo endocrine evaluation. |