Anterior pituitary dysfunction in moderate-to-severe chronic traumatic brain injury patients and the influence on functional outcome

Park, Ki Deok; Kim, Deog Young; Lee, Ju Kang; Nam, Hee-Seung; Park, Yoon Ghil

doi:10.3109/02699052.2010.506863

Cited by 39 publications

(26 citation statements)

References 14 publications

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“…Only one study evaluated neurological prognosis using the extended Clasgow Outcome Scale and found no association with anterior pituitary disorders (37). Two studies (88 patients) suggested impaired functional status on the Functional Independence Measure scale with anterior pituitary disorders at rehabilitation admission (38,39), whereas two studies (117 patients) suggested impaired improvement of Functional Independence Measure scores during rehabilitation (38,40). Two studies (120 patients) showed impaired quality of life using the SF-36 questionnaire (37,41).…”

Section: Clinical Outcomes Of Anterior Pituitary Disordersmentioning

confidence: 99%

“…Only two studies quantitatively reported the effect of secondary brain injuries (hypoxemia and hypotension) on anterior pituitary disorders and found no association (33,37). One study observed a nonsignificant association between anterior pituitary disorders and diffuse axonal injury (40). Two studies evaluated MRI during the recovery phase and suggested that patients with pituitary disorders were more likely to have MRI pituitary abnormalities such as empty sella (33,46).…”

Section: Predictors Of Anterior Pituitary Disordersmentioning

confidence: 99%

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Clinical Outcomes, Predictors, and Prevalence of Anterior Pituitary Disorders Following Traumatic Brain Injury

Lauzier

Turgeon

Boutin

et al. 2014

Critical Care Medicine

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Approximately one third of traumatic brain injury patients have persistent anterior pituitary disorder. Older age, traumatic brain injury severity, and skull fractures predict anterior pituitary disorders, which in turn may be associated with higher ICU mortality. Further high-quality studies are warranted to better define the burden of anterior pituitary disorders and to identify high-risk patients.

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Section: Clinical Outcomes Of Anterior Pituitary Disordersmentioning

confidence: 99%

Section: Predictors Of Anterior Pituitary Disordersmentioning

confidence: 99%

Clinical Outcomes, Predictors, and Prevalence of Anterior Pituitary Disorders Following Traumatic Brain Injury

Lauzier

Turgeon

Boutin

et al. 2014

Critical Care Medicine

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Gardner

Mattsson

Daousi

et al. 2015

European Journal of Endocrinology

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Objective: Prevalence of GH deficiency (GHD) caused by traumatic brain injury (TBI) is highly variable. Short-term studies show improvement in quality of life (QoL) during GH replacement (GHR), but long-term data are lacking. The aim of this study was to analyse the clinical characteristics of post-traumatic hypopituitarism and the QoL effects of long-term GHR. Design/methods: Pfizer International Metabolic Database patients with GHD caused by TBI and by non-functioning pituitary adenoma (NFPA) were compared regarding: clinical characteristics at baseline and 1-year of GHR, and QoL response up to 8-years of GHR (QoL-AGHDA total scores and dimensions) in relationship with country-specific norms. Results: TBI patients compared with NFPA patients were younger, diagnosed with GHD 2.4 years later after primary disease onset (P!0.0001), had a higher incidence of isolated GHD, higher GH peak, a more favourable metabolic profile and worse QoL, were shorter by 0.9 cm (1.8 cm when corrected for age and gender; PZ0.004) and received higher GH dose (mean difference: 0.04 mg/day PZ0.006). In TBI patients, 1-year improvement in QoL was greater than in NFPA (change in QoL-AGHDA score 5.0 vs 3.5, respectively, PZ0.04) and was sustained over 8 years. In TBI patients, socialisation normalised after 1 year of GHR, self-confidence and tenseness after 6 years and no normalisation of tiredness and memory was observed. Conclusion: Compared with NFPA, TBI patients presented biochemically with less severe hypopituitarism and worse QoL scores. GHR achieved clinically relevant, long-term benefit in QoL.

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“…GH deficiency has been associated with more severe deficits in memory, attention, executive function, mood, and sleep, as well as being associated with fatigue, many of which are often reported as postconcussive symptoms. [3][4][5][6][7][8][9][10] GH also may play a critical role in recovery, as it is involved in both myelin formation [11][12][13] and neuronal plasticity. [14][15][16][17] A number of potential pathophysiological mechanisms have been suggested as to how the pituitary gland is damaged.…”

mentioning

confidence: 99%

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

Greco¹,

Hovda²,

Prins³

2013

Journal of Neurotrauma

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Adolescents are one of the highest groups at risk for sustaining both traumatic brain injury (TBI) and repeat TBI (RTBI). Consequences of endocrine dysfunction following TBI have been routinely explored in adults, but studies in adolescents are limited, and show an incidence rate of endocrine dysfunction in 16-61% in patients, 1-5 years after injury. Similar to in adults, the most commonly affected axis is growth hormone (GH) and insulin-like growth hormone 1 (IGF-1). Despite TBI being the primary cause of morbidity and mortality among the pediatric population, there are currently no experimental studies specifically addressing the occurrence of pituitary dysfunction in adolescents. The present study investigated whether a sham, single injury or four repeat injuries (24 h interval) delivered to adolescent rats resulted in disruption of the GH/IGF-1 axis. Circulating levels of basal GH and IGF-1 were measured at baseline, 24 h, 72 h, 1 week, and 1 month after injury, and vascular permeability of the pituitary gland was quantified via Evans Blue dye extravasation. Changes in weight and length of animals were measured as a potential consequence of GH and IGF-1 disruption. The results from the current study demonstrate that RTBI results in significant acute and chronic decreases in circulation of GH and IGF-1, reduction in weight gain and growth, and an increase in Evans Blue dye extravasation in the pituitary compared with sham and single injury animals. RTBI causes significant disruption of the GH/IGF-1 axis that may ultimately affect normal cognitive and physical development during adolescence.

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Anterior pituitary dysfunction in moderate-to-severe chronic traumatic brain injury patients and the influence on functional outcome

Abstract: These findings strongly suggest that patients who suffer head trauma should be routinely tested for anterior pituitary hormone deficiency.

Cited by 39 publications

References 14 publications

Clinical Outcomes, Predictors, and Prevalence of Anterior Pituitary Disorders Following Traumatic Brain Injury

Clinical Outcomes, Predictors, and Prevalence of Anterior Pituitary Disorders Following Traumatic Brain Injury

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

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

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