Abstract
ObjectivePituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices is commonly seen in soldiers returning from recent conflicts. We investigated: (1) the prevalence and consequences of pituitary dysfunction following moderate to severe bTBI and (2) whether it is associated with particular patterns of brain injury.MethodsNineteen male soldiers with moderate to severe bTBI (median age = 28.3 years) and 39 male controls with moderate to severe nonblast TBI (nbTBI; median age = 32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment.ResultsSix of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (p = 0.004). Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency, and 1 had combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than in those without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism.InterpretationWe reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe bTBI, which was more frequent than in a matched group of civilian moderate to severe nbTBI subjects. We recommend that all patients with moderate to severe bTBI should routinely have comprehensive assessment of endocrine function. Ann Neurol 2013;74:527–536
Highlights
Interpretation: We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe Blast TBI (bTBI), which was more frequent than in a matched group of civilian moderate to severe nonblast TBI (nbTBI) subjects
Patient Characteristics All soldiers with bTBI had been injured by improvised explosive devices (IEDs) and had been wearing full personal protective equipment
Neuroimaging Results In the bTBI group, we investigated whether particular structural abnormalities were associated with pituitary dysfunction
Summary
Pituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Nonblast TBI (nbTBI) is a recognized cause of pituitary dysfunction, in particular growth hormone (GH) deficiency.[5] Reported prevalence rates of pituitary dysfunction following nbTBI vary between 2 and 68%.5,6 This variability is due in part to differences in the normal ranges and dynamic endocrine tests used, the time since injury, and injury severity.[5,6,7] In addition to adverse metabolic consequences, hypopituitarism causes multiple symptoms impacting on physical and psychological well-being that will impair recovery after TBI, and hormone replacement represents an important therapeutic opportunity.[8,9,10,11] It is unknown how often bTBI leads to pituitary dysfunction.[12]. We investigated the prevalence and associations of pituitary dysfunction in soldiers after moderate to severe bTBI compared to a control group of patients after nbTBI
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
