Endocrine Abstracts

Introduction: Recently, it has been suggested that hypopituitarism developed after the brain injury has implications in the final recovery of the patients. We hypothesize that hypopituitarism developed in the course of traumatic brain injury (TBI) or non-TBI is related to worse functional outcome. The aim was to assess the association between hypopituitarism in the early recovery phase and long-term functional outcome.

Materials and methods: We included 157 brain-injured patients (107 TBI; 50 non-TBI) referred to the Department of Neurorehabilitation, Hvidovre Hospital from 06/2007–05/2011. Pituitary assessment including a 250 μg Synacthen® test was performed 3.5 (±1.5) months post-injury. Insufficiencies were defined as pituitary and peripheral hormone concentrations in relation to local gender and age-related reference ranges. Functional outcome was assessed by Glasgow outcome scale-extended (GOS-E), functional independence measure (FIM), and Rancho Los Amigos scale at 1-year follow-up.

Results: Hormone alterations were observed in 72.5% of the patients. Hyperprolactinaemia, secondary hypogonadism, and hypothyroidism were recorded in 50, 21, and 9% of TBI patients and in 48, 22, and 17% of non-TBI patients, respectively. Adrenal insufficiency was recorded in one non-TBI patient. Presence of secondary insufficiencies was unrelated to aetiology, shearing lesions, time since injury and antiepileptic drug treatment. Hyperprolactinaemia was related to longer posttraumatic amnesia (P=0.02). Hyperprolactinaemia and secondary hypogonadism were related to worse outcome at 1 year follow-up, as measured by FIM (P<0.03) and GOS-E (P<0.01). In non-TBI patients no such relations were demonstrated.

Conclusion: A substantial number of severely brain-injured patients had hormonal alterations approximately 3-months post-injury. In the TBI group, hyperprolactinaemia and secondary hypogonadism was related to poorer outcome. The importance of the observed alterations for the rehabilitation process, and the long-term consequences, however, remain to be proven.