ECE2015 Eposter Presentations Pituitary: clinical (121 abstracts)
Symptoms of gonadal dysfunction are more predictive of hypopituitarism than non-specific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury
Martin Cuesta Hernandez 1 , Mark J Hannon 1 , Rachel K Crowley 1 , Lucy Ann Behan 1 , William Tormey 2 , Daniel Rawluk 3 , Mark Delargy 4 , Amar Agha 1 & Christopher J Thompson 1
1Academic Department of Endocrinology. Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 2Department of Chemical Pathology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 3National Neurosurgery Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland; 4National Rehabilitation Unit, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
Context: The economic and logistic burden of screening for hypopituitarism following moderate/severe traumatic brain injury (TBI) is considerable. Published guidelines suggest prioritisation for screening of patients with symptoms of pituitary dysfunction.
Objective: To evaluate the implementation of targeted symptom-based screening for hypopituitarism after moderate/severe TBI, compared with routine consecutive screening.
Design: Group 1 (G1); consecutive patients were screened. Group 2 (G2); screening targeted based on symptoms of pituitary dysfunction. Setting: G1 patients were recruited from the Irish National Neurosurgery Centre and in G2 on symptom based referral from external caregivers. Patients: G1, 137 patients (113 male) and G2 111 patients (77 male) referred for pituitary evaluation (G2).
Main outcome measures: The rate of pituitary hormone deficiency between groups.
Results: Patients with menstrual dysfunction (n=10) had more GH (50% vs 11%, P=0.001), ACTH (60% vs 14%, P<0.0001) or gonadotrophin (90% vs 16%, P<0.0001) deficiency and any pituitary hormone deficit (100% vs 33%, P<0.0001) than G1. Men with symptomatic hypogonadism (n=12) had more GH (33% vs 11%, P=0.03), gonadotrophin (58% vs 16%, P<0.0001) and TSH (16% vs 1%, P=0.03) deficiency than G1. Patients with non-specific symptoms (n=89) were no more likely to have hypopituitarism than those consecutively screened. The rates of GH (19% vs 11%, P=0.12), ACTH (14% vs 14%, P=0.99), TSH (3% vs 1%, P=0.34), ADH (7% vs 2%, P=0.44) or any pituitary hormone deficit (25% vs 33%, P=0.21) were not different between those referred with non-specific symptoms in G2 and G1.
Conclusions: Symptoms of hypogonadism are sufficiently predictive of hypopituitarism to justify inclusion in protocols for screening for hypopituitarism after moderate/severe TBI. Non-specific symptoms of hypopituitarism are no more predictive than systematic screening in identifying pituitary hormone deficits: their place as indicators for screening is therefore questionable.
Disclosure: The work in this study was supported by unrestricted grants from Pfizer Pharmaceuticals and Novo Nordisk Pharmaceuticals.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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