Late pituitary dysfunction and its relation to global outcome in patients with mild traumatic brain injury

Abstract

The aims of this study were to determine the prevalence of pituitary dysfunction in patients presenting with cognitive and/or mood complaints and/or fatigability late after a mild traumatic brain injury (TBI), and to analyse the relations of endocrine abnormalities with population characteristics, imagery and autonomy. We studied 38 patients: 25 men, mean age 36 (range 21–60 years), at a mean of 23 months (range 9–40) post-event; 44.7% were GOS 1, 47.4% GOS 2 (moderate disability) and 7.9% GOS 3 (severe disability). 15 patients were active. For each patient, we collected data on initial CT scan, MRI lesions, late Glasgow Outcome Scale (GOS), autonomy (EBIS questionnaire) and pituitary functions (static and dynamic tests). No patient showed any posterior pituitary dysfunction. One (2.6%) showed a hyperprolactinemia, two (5.3%) a gonadotropin deficiency, seven (18.4%) a TSH deficiency. Nine patients (23.7%) had partial ACTH deficiency (diagnosed by ITT or metyrapone test). Severe GH deficiency (GHD) was diagnosed in nine patients (23.7%) (ITT or arginine + GHRH test) and was isolated in 39% of cases. Twenty-three patients (60.5%) showed at least one anterior pituitary deficiency requiring a substitutive treatment. Hypopituitarism was only related to age (positive correlation, P = 0.01) and the presence of a cerebral oedema on initial CT scan ( P = 0.044). We didn’t find any association with autonomy in activities, GOS score and MRI data. In mild TBI patients with persistent cognitive disorders, fatigability or mood disorder, the risk of anterior pituitary deficiency is high and justifies a systematic pituitary assessment with specific reference tests.