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Exp Clin Endocrinol Diabetes 2006; 114(6): 316-321
DOI: 10.1055/s-2006-924254
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Hypopituitarism following Severe Traumatic Brain Injury

B. L. Herrmann1 , 2 , J. Rehder2 , S. Kahlke2 , H. Wiedemayer3 , A. Doerfler4 , W. Ischebeck5 , R. Laumer6 , M. Forsting4 , D. Stolke3 , K. Mann2
  • 1Institute of Cardio-Diabetes, Technology-Center Bochum, Bochum, Germany
  • 2Department of Endocrinology, University Hospital of Essen, Essen, Germany
  • 3Department of Neurosurgery, University Hospital of Essen, Essen, Germany
  • 4Department of Neuroradiology, University Hospital of Essen, Essen, Germany
  • 5Clinic of Neurosurgical Rehabilitation, University Witten/Herdecke, Witten, Germany
  • 6Department of Neurosurgery, Alfried-Krupp-Clinic, University of Essen, Essen, Germany
Further Information

Publication History

Received: July 9, 2005 First decision: October 21, 2005

Accepted: February 3, 2006

Publication Date:
26 July 2006 (online)

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Abstract

Although hypopituitarism is a known complication of traumatic head injury, it may be under-recognized due to its subtle clinical manifestations. To address this issue, we determine the prevalence of neuroendocrine abnormalities in patients rehabilitating from severe traumatic brain injury (Glasgow Coma Scale ≤ 8). 76 patients (mean age 39 ± 14 yr; range 18 - 65; 53 males and 23 females; BMI 25.8 ± 4.2 kg/m²; mean ± SD) with a severe traumatic brain injury, an average of 22 ± 10 months before this study (median, 20 months), underwent a series of standard endocrine tests, including TSH, free T4, T4, T3, prolactin, testosterone (males), estradiol (females), cortisol, ACTH, GH, and IGF‐I. All subjects also underwent GH response to GHRH + arginine. Growth hormone deficiency (GHD) was defined as a GH response < 9 µg/L to GHRH + arginine and was confirmed by ITT (< 3 µg/L). Pituitary deficiency was shown in 24 % of the patients (18/76). 8 % (n = 6) had GHD (GH-peak range [GHRH + arginine]: 2.8 - 6.3 µg/L; GH-peak range [ITT]: 1.5 - 2.2 µg/L; IGF‐I range: 62 - 174 µg/L). 17 % (n = 13) had hypogonadism (total testosterone < 9.5 nmol/L and low gonadotropins in 12 males; low estradiol, and low gonadotropins in 1 female). Total testosterone levels did not correlate with BMI or age. 2 males with hypogonadism also showed a mild hyperprolactinemia (33 and 41 ng/ml). 3 % (n = 2) patients had partial ACTH-deficiency (cortisol-peak [ITT] 392 and 417 nmol/L) and 3 % (n = 2) had TSH-deficiency. In summary, we have found hypopituitarism in one-fourth of patients with predominantly secondary hypogonadism and GHD. These findings strongly suggest that patients who suffer head trauma must routinely include neuroendocrine evaluations.

Key words

Severe traumatic brain injury - hypopituitarism

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M.D. Burkhard L. Herrmann

Institute of Cardio-Diabetes
Technology-Center of Bochum

Universitätsstraße 142

44799 Bochum

Germany

Phone: + 49-234-7099057

Fax: + 49-234-7099058

Email: herrmann@kardio-diabetes.biz

Email: burkhard.herrmann@uni-essen.de

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