ECE2013 Poster Presentations Pituitary – Clinical (<emphasis role="italic">Generously supported by IPSEN</emphasis>) (127 abstracts)
The prevalence of insufficient test responses in patients with traumatic brain injury compared to healthy controls – results from The Danish National Study on posttraumatic hypopituitarism
Marianne Klose 1 , Peter Laurberg 4 , Louise Frederiksen 3 , Kirstine Stochholm 2 , Jurgita Janukonyté 2 , Jens Sandahl Christiansen 2 , Marianne Andersen 3 & Ulla Feldt-Rasmussen 1
1Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2Aarhus University Hospital, Aarhus, Denmark; 3Odense University Hospital, Odense, Denmark; 4Aalborg University Hospital, Aalborg, Denmark.
Introduction: We questioned the justification of general recommendations for assessment of hypopituitarism in patients with traumatic brain injury (TBI), and aimed to describe the prevalence of hypopituitarism in a national TBI population of patients admitted to a Danish hospital in 2008, as compared to healthy controls.
Patients and methods: We included 463 patients (18–65 years) hospitalized ≥24 h, with more than subtle TBI as indicated by loss of consciousness, amnesia, or cranial/cerebral imaging abnormalities. The patients underwent endocrine assessment median 2.5 years (range 1.0–4.4) post TBI. Assessment included baseline evaluation of thyroid and gonadal hormone concentrations, and dynamic assessment of the GH and HPA axis. Results were compared to those from healthy controls. Deficiencies were defined according to local assay and test specific cut-offs.
Results: An insufficient 30 min cortisol response to Synacthen® stimulation was more frequently seen in patients 26/344 (7.1%) than controls 0/113 (0%) (P=0.01), whereas an insufficient response to ITT was seen equally frequent in patients 9/204 (4.6%) and controls 3/116 (2.6%) (P=0.7). An insufficient response to PD-GHRH or GHRH-arginine was seen more often in patients 47/360 (11.6%) than controls 2/93 (2.1%) (P<0.01), whereas an insufficient peak GH to ITT was equally frequent in patients 9/200 (4.5%) and controls 2/88 (2.3%) (P=0.4). A total testosterone below the lower cut-off was seen in 32/300 (10.7%) male patients vs 0/62 (0%) controls (P=0.01). In women, hypogonadism could not be excluded in 4/152 (2.6%) female patients vs 1/32 (3.1%) controls (P=0.9). Free T4 combined with an inappropriately low TSH was seen in 5/461 (1.1%) patients vs 3/96 (3.1%) controls (P=0.1).
Conclusion: This nationwide study of TBI patients assessed 2.5 years after the injury illustrates that the chosen methodology is very important when defining the prevalence of pituitary insufficiency. Hormonal responses in TBI patients may or may not differ from what should be expected from healthy controls.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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