Endocrine Abstracts

Introduction: Severe brain injury is usually sustained as a result of road traffic accident or high impact fall. Initial presentation of patients depends upon the severity of brain injury. Survivors of severe brain injury carry significant morbidity and often need prolonged period of rehabilitation. About one third of these patients are suspected to have partial or complete pituitary dysfunction which can manifest insidiously many months after the initial insult. Recognition and treatment of pituitary dysfunction is very important for the initial recovery, long-term health, quality of life and general wellbeing.

Method: At Hurstwood Park Neurosurgical Centre, we studied 40 patient records that presented over a period of 3 years from 2010 to 2012 and followed them up for at least one year to look for any evidence of their pituitary function tests performed either in the hospital or in the community. Severe brain injury for the purpose of this study was defined on the basis of Glasgow Coma Scale less than 8 on presentation combined with radiological evidence of brain injury/haemorrhage with or without skull fracture. Information was collected from hospital electronic database, pathology department and by contacting primary care for tests performed elsewhere. Pituitary function tests were followed at 7 days, 3, 6 and 12 month intervals from initial injury.

Results: Out of the 40 patients, 4 died during admission and remaining 36 patients had an average length of stay in hospital of 70.5 days (minimum 12, maximum 266 days).

3 patients (7.5%) had all the pituitary function tests performed at some point in time but only one (2.5%) was followed through the year. At 3 months one patient had IGF1, TFTs and cortisol, 2 had cortisol and TFTs, 4 had TFTs only out of which 3 had repeat TFTs at one year. The acute cortisol (1–7 days) was assessed only for 7 patients (17.5%).

Conclusion: None of the above patients had a structured pituitary or endocrine follow-up and more than two thirds of patients did not have any sort of pituitary function assessment at any time during one year period following injury. Some of these patients may have unrecognised pituitary dysfunction. Currently there are no national guidelines on the management and follow-up of survivors of severe brain injury with regards to their pituitary health and this study stresses the need for the development of such guidelines.