ECE2007 Poster Presentations (1) (659 abstracts)
Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury (TBI) in a German multi-centre screening program
Christian Berg 1 , Alexandra Oeffner 4 , Petra Maria Schumm-Draeger 4 , Georg Brabant 2 , B Gerbert 3 , Matthias Weber 5 , Klaus Mann 1 & Burkhard Herrmann 6
1University of Duisburg-Essen, Clinic of Endocrinology, Essen, Germany; 2University of Hannover, Hannover, Germany; 3University of Dresden, Dresden, Germany; 4University of Munich, Klinikum Bogenhausen, Munich, Germany; 5University of Mainz, Mainz, Germany; 6Institute of Cardio-Diabetes, Technology-Centre, Bochum, Germany.
Recent data suggest that hypopituitarism is a common complication of TBI. Prevalence differs between 10–40% and is based on different diagnostic tests and criteria. Hence, under field conditions TBI-mediated hypopituitarism may be less frequent than previously thought. 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 (43±14 yrs; 133 males, 12±8 months after TBI) underwent baseline endocrine testing with central assessment of TSH, free T4, prolactin, LH, FSH, testosterone (m), estradiol (f), cortisol and IGF-I. If IGF-I was <−1 SDS GHRH+arginine or insulin tolerance test 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, and <3 microg/L in ITT. Hypocortisolism was defined when basal cortisol was <200 nmol/l and confirmed by ITT.
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% (n=46) had an IGF-I of <−1 SDS. In 4% (n=9) GHD was confirmed. IGF-I did not correlate with BMI, gender or time after injury, but with age (P=0.03). 9% (n=23) had hypogonadism (total testosterone <9.5 nmol/L /low estradiol and low gonadotropins). Total testosterone levels did not correlate with BMI or age. 10.7% (n=35) had mild hyperprolactinemia. 4% (n=11) had hypocortisolism and 1% (n=3) had confirmed ACTH-deficiency. 12% (n=29) had TSH-deficiency.
Conclusion: In summary, in this large series carried out on an unselected group of TBI survivors we could not confirm a high prevalence of anterior pituitary dysfunction. Only every fifth patient with low IGF-I had confirmed GHD according to strict criteria and based on BMI-dependent cut-off values for GHRH+arginine testing. Hence IGF-I is a poor predictor for GHD in TBI.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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