Document Detail


Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury.
MedLine Citation:
PMID:  15355447     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Acquired hypopituitarism in adults is obviously suspected in patients with primary hypothalamic-pituitary diseases, particularly after neurosurgery and/or radiotherapy. That brain injuries (BI) can cause hypopituitarism is commonly stated and has been recently emphasized but the management of BI patients does not routinely include neuroendocrine evaluations. AIM: To clarify the occurrence of hypopituitarism in patients after traumatic brain injury (TBI) or subarachnoid haemorrhage (SAH) 3 months after the BI. SUBJECTS AND METHODS: The occurrence of hypopituitarism in conscious patients after traumatic brain injury [TBI, n = 100, 31 women, 69 men; age 37.1 +/- 1.8 years; body mass index (BMI) 23.7 +/- 0.4 kg/m(2); Glasgow Coma Scale (GCS) 3-15] or subarachnoid haemorrhage [SAH, n = 40, 14 men, 26 wpmen, 51.0 +/- 2.0 years; 25.0 +/- 0.6 kg/m(2); Fisher's scale 1-4] was studied in a multicentre study 3 months after the BI. All patients underwent wide basal hormonal evaluation; the GH/IGF-I axis was evaluated by GHRH + arginine test and IGF-I measurement. RESULTS: In TBI patients, some degree of hypopituitarism was shown in 35%. Total, multiple and isolated deficits were present in 4, 6 and 25%, respectively. Diabetes insipidus was present in 4%. Secondary adrenal, thyroid and gonadal deficit was present in 8, 5 and 17%, respectively. Severe GH deficiency (GHD) was the most frequent pituitary defect (25%). In SAH patients, some degree of hypopituitarism was shown in 37.5%. Despite no total hypopituitarism, multiple and isolated deficits were present in 10 and 27.5%, respectively. Diabetes insipidus was present in 7.5%. Secondary adrenal, thyroid and gonadal deficit was present in 2.5, 7.5 and 12.5%, respectively. Severe GHD was the most frequent defect (25%). CONCLUSIONS: TBI and SAH are conditions associated with high risk of acquired hypopituitarism. The pituitary defect is often multiple and severe GHD is the most frequent defect. Thus neuroendocrine evaluations are always mandatory in patients after brain injuries.
Authors:
Gianluca Aimaretti; Maria Rosaria Ambrosio; Carolina Di Somma; Alessandra Fusco; Salvatore Cannavò; Maurizio Gasperi; Carla Scaroni; Laura De Marinis; Salvatore Benvenga; Ettore Carlo degli Uberti; Gaetano Lombardi; Franco Mantero; Enio Martino; Giulio Giordano; Ezio Ghigo
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical endocrinology     Volume:  61     ISSN:  0300-0664     ISO Abbreviation:  Clin. Endocrinol. (Oxf)     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-09     Completed Date:  2005-03-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0346653     Medline TA:  Clin Endocrinol (Oxf)     Country:  England    
Other Details:
Languages:  eng     Pagination:  320-6     Citation Subset:  IM    
Affiliation:
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Arginine / diagnostic use
Brain Injuries / blood,  complications*
Female
Growth Hormone / blood
Growth Hormone-Releasing Hormone / diagnostic use
Humans
Hypopituitarism / blood,  diagnosis,  etiology*
Insulin-Like Growth Factor I / analysis
Male
Middle Aged
Pituitary Gland / physiopathology
Subarachnoid Hemorrhage / blood,  complications*
Time Factors
Chemical
Reg. No./Substance:
67763-96-6/Insulin-Like Growth Factor I; 74-79-3/Arginine; 9002-72-6/Growth Hormone; 9034-39-3/Growth Hormone-Releasing Hormone

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