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Exp Clin Endocrinol Diabetes 2010; 118(2): 139-144
DOI: 10.1055/s-0029-1225611
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Prevalence of Anterior Pituitary Dysfunction in Patients following Traumatic Brain Injury in a German Multi-centre Screening Program

C. Berg 1 , A. Oeffner 2 , P.-M. Schumm-Draeger 2 , F. Badorrek 3 , G. Brabant 3 , 4 , B. Gerbert 5 , S. Bornstein 5 , A. Zimmermann 6 , M. Weber 6 , M. Broecker-Preuss 1 , K. Mann 1 , B. L. Herrmann 1 , 7
  • 1Clinic of Endocrinology, University Hospital of Essen, Germany
  • 2Med. Clinic III, Hospital Bogenhausen, Munich, Germany
  • 3Department of Endocrinology, University Hospital of Hannover, Germany
  • 4Department of Endocrinology, Christie Hospital, Manchester, United Kingdom
  • 5Department of Endocrinology, University Hospital of Dresden, Germany
  • 6Department of Endocrinology, University Hospital of Mainz, Germany
  • 7Endocrinology and Diabetology, Technology Centre of Bochum, Germany
Weitere Informationen

Publikationsverlauf

received 29.10.2008

first decision 20.05.2009 accepted 04.06.2009

Publikationsdatum:
18. August 2009 (online)

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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.

Key words

hypopituitarism - insufficiencies - GH adrenal gland - hormones - cerebrovascular disease - neuropathy

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Correspondence

C. BergMD 

Clinic for Endocrinology

University of Duisburg-Essen

University Clinic of Essen

Telefon: +49/201/723 842 11

Fax: +49/201/723 57 99

eMail: christian.berg@uni-essen.de