Incidence of pituitary dysfunction following traumatic brain injury: A prospective study from a regional neurosurgical centre

Alavi, Seyed A.; Tan, Chin Lik; Menon, David; Simpson, Helen; Hutchinson, Peter J.

doi:10.3109/02688697.2015.1109060

Cited by 27 publications

(14 citation statements)

References 15 publications

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“…Several studies reported posttraumatic hypopituitarism occurred in a range from 21.3% to 31% after TBI. Prevalence of hypogonadism was estimated at about 1.9% to 17.1% ( Alavi, Tan, Menon, Simpson, & Hutchinson, 2016 ; Schneider, Kreitschmann-Andermahr, Ghigo, Stalla, & Agha, 2007 ; Silva et al, 2015 ). Patients with symptoms of hypogonadism (that included ED) after TBI were even more predictive of hypopituitarism than other symptoms (58% vs 16%, P <.0001) ( Cuesta et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

et al. 2018

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Introduction:In our study, we aimed to investigate the association between a traumatic brain injury (TBI) and subsequent erectile dysfunction (ED). This is a population-based study using the claims dataset from The National Health Insurance Research Database.Methods:We included 72,642 patients with TBI aged over 20 years, retrospectively, selected from the longitudinal health insurance database during 2000–2010, according to the ICD-9-CM. The control group consisted of 217,872 patients without TBI that were randomly chosen from the database at a ratio of 1:3, with age- and index year matched. Cox proportional hazards analysis was used to estimate the association between the TBI and subsequent ED.Results:After a 10-year follow-up, the incidence rate of ED was higher in the TBI patients when compared with the non-TBI control group (24.66 and 19.07 per 100,000, respectively). Patients with TBI had a higher risk of developing ED than the non-TBI cohort after the adjustment of the confounding factors, such as age, comorbidity, residence of urbanization and locations, seasons, level of care, and insured premiums (adjusted hazard ratio (HR) = 2.569, 95% CI [1.890, 3.492], p < .001).Conclusion:This is the first study using a comprehensive nationwide database to analyze the association of ED and TBI in the Asian population. After adjusted the confounding factors, patients with TBI have a significantly higher risk of developing ED, especially organic ED, than the general population. This finding might remind clinicians that it’s crucial in early identification and treatment of ED in post-TBI patients.

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Section: Discussionmentioning

confidence: 99%

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

et al. 2018

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“…5 A recent investigation identified corticosteroid insufficiency in 10.3% of patients in the first week after trauma. 17 Multiple measurements were not taken for the first 24 h and consequently no threshold values or data could be derived for the early clinical phase. 17 Another approach in critical care patients used stimulation testing and found insufficiency in 24 patients.…”

Section: Discussionmentioning

confidence: 99%

Initial free cortisol dynamics following blunt multiple trauma and traumatic brain injury: A clinical study

Kusmenkov

Braunstein

et al. 2019

J Int Med Res

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Objective To determine free and total cortisol serum concentrations in the first 24 h after trauma and to evaluate the influence of traumatic brain injury (TBI) on their dynamics. Methods This prospective cohort study enrolled patients who had experienced multiple trauma and were admitted to a level 1 trauma centre. The patients were divided in two groups based on the presence of TBI according to clinical and radiological findings. Blood was collected initially as well as at 12 h and 24 h after the traumatic injury. Total cortisol, corticosteroid binding globulin (CBG) and free cortisol levels were determined. Results The study analysed data from 49 patients (36 males and 13 females) with a mean ± SD age of 45.0 ± 16.0 years. Of these, 36 presented with TBI and 13 had multiple injuries without TBI. Patients with TBI showed significantly lower concentrations of total cortisol and free cortisol compared with patients without TBI. Repeated measures analysis revealed different concentration dynamics in patients with TBI, with no increase in cortisol after trauma. Conclusion Multiple trauma patients with TBI are at risk of acute impaired cortisol secretion and show an attenuated stress response as early as 12 h after injury.

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“…The literature contains reported rates of chronic hypopituitarism post-TBI which range from 15% to 69% (3,19,32,33,43,46,47,48,49,50,51,52,53,54,55,56,57,58,59). Published cohort studies vary widely in methods of patient selection, severity of head injury included and the timing and methods of testing for hypopituitarism ( Table 1).…”

Section: Anterior Pituitarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

Garrahy

Sherlock

Thompson

2017

European Journal of Endocrinology

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Advances in the management of traumatic brain injury, subarachnoid haemorrhage and intracranial tumours have led to improved survival rates and an increased focus on quality of life of survivors. Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described. Unrecognised acute hypopituitarism, particularly ACTH/cortisol deficiency and diabetes insipidus, can be life threatening. Although hypopituitarism may be transient, up to 30% of survivors of TBI have chronic hypopituitarism, which can diminish quality of life and hamper rehabilitation. Patients who survive SAH may also develop hypopituitarism, though it is less common than after TBI. The growth hormone axis is most frequently affected. There is also accumulating evidence that survivors of intracranial malignancy, who have required cranial irradiation, may develop hypopituitarism. The time course of the development of hormone deficits is varied, and predictors of pituitary dysfunction are unreliable. Furthermore, diagnosis of GH and ACTH deficiency require dynamic testing that can be resource intensive. Thus the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services. However, diagnosis and management of pituitary dysfunction can be rewarding. Appropriate hormone replacement can improve quality of life, prevent complications such as muscle atrophy, infection and osteoporosis and improve engagement with physiotherapy and rehabilitation.

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Incidence of pituitary dysfunction following traumatic brain injury: A prospective study from a regional neurosurgical centre

Cited by 27 publications

References 15 publications

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

Risk of Erectile Dysfunction After Traumatic Brain Injury: A Nationwide Population-Based Cohort study in Taiwan

Initial free cortisol dynamics following blunt multiple trauma and traumatic brain injury: A clinical study

MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients

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