A Five Year Prospective Investigation of Anterior Pituitary Function after Traumatic Brain Injury: Is Hypopituitarism Long-Term after Head Trauma Associated with Autoimmunity?

Abstract

Traumatic brain injury (TBI) has been recently recognized as a common cause of pituitary dysfunction. However, there are not sufficient numbers of prospective studies to understand the natural history of TBI induced hypopituitarism. The aim was to report the results of five years' prospective follow-up of anterior pituitary function in patients with mild, moderate and severe TBI. Moreover, we have prospectively investigated the associations between TBI induced hypopituitarism and presence of anti-hypothalamus antibodies (AHA) and anti-pituitary antibodies (APA). Twenty five patients (20 men, five women) were included who were prospectively evaluated 12 months and five years after TBI, and 17 of them also had a third-year evaluation. Growth hormone (GH) deficiency is the most common pituitary hormone deficit at one, three, and five years after TBI. Although most of the pituitary hormone deficiencies improve over time, there were substantial percentages of pituitary hormone deficiencies at the fifth year (28% GH, 4% adrenocorticotropic hormone [ACTH], and 4% gonadotropin deficiencies). Pituitary dysfunction was significantly higher in strongly AHA- and APA-positive (titers ≥1/16) patients at the fifth year. In patients with mild and moderate TBI, ACTH and GH deficiencies may improve over time in a considerable number of patients but, although rarely, may also worsen over the five-year period. However in severe TBI, ACTH and GH status of the patients at the first year evaluation persisted at the fifth year. Therefore, screening pituitary function after TBI for five years is important, especially in patients with mild TBI. Moreover, close strong associations between the presence of high titers of APA and/or AHA and hypopituitarism at the fifth year were shown for the first time.

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

“…There is evidence to demonstrate that following a traumatic brain injury (TBI), patients are at significant risk of developing post-traumatic hypopituitarism (PTHP) (1,2,3,4,5,6,7,8,9,10,11,12,13,14). Following TBI, patients have significantly reduced quality of life (QoL) and cognitive indices (15,16).…”

Different Sports in Adolescence: Effect on Lipid Profile, Glucose Metabolism, Body Composition, Bone Density, Bone Quality, Bone Markers, Vascular Function and Structure, Pituitary and Hypothalamic Antibodies

“…These findings are strongly in agreement with those of a recently published paper reporting, in a five years prospective investigation, a significant increase of anti-pituitary antibodies even after mild brain trauma. 8 The appearance of these antibodies has been suggested to be the consequence of the head trauma triggering an ongoing cascade of vascular and histopathological alterations involving mediators of inflammatory process, thus favoring the immune system activation which can contribute to late pituitary dysfunction. 7,8 The presence of these antibodies is in fact considered a reliable prognostic factor for future pituitary dysfunction even in subjects with mild brain trauma; 8 these antibodies therefore might identify those athletes at risk of developing pituitary dysfunction in the future.…”

“…The association of hypopituitarism due to TBI with the presence of Anti-hypothalamus antibodies (AHA) and Anti-pituitary antibodies (APA) was found after long-term follow up. 7,8 The aim of this study was therefore to investigate the effects of four different sports; ski, swimming, rugby and hockey in a group of young athletes training intensively. We evaluated in particular about the lipid profile, insulin sensitivity, bone health and mineralization, the cardiovascular risk factors and the presence of anti-hypothalamus and anti-pituitary antibodies.…”

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: A Neuroendocrine Approach to Patients With Traumatic Brain Injury

“…Among 240 patients studied prospectively, there were 50 new hormone deficiencies and 113 recoveries of an endocrine axis by 12 months after TBI (2). There are limited data regarding the natural history of hypopituitarism several years after TBI (10).…”