Abstract
Objective
Pituitary dysfunction is a recognised consequence of traumatic brain injury (TBI) causing cognitive, psychological and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices (IEDs) is commonly seen in soldiers returning from recent conflicts. We investigated: (i) the prevalence and consequences of pituitary dysfunction following moderate-severe bTBI, and (ii) whether it is associated with particular patterns of brain injury.
Methods
Nineteen male soldiers with moderate-severe bTBI (median age 28.3 years), and 39 male controls with moderate-severe non-blast TBI (nbTBI) (32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment.
Results
Six of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (P=0.004). Two soldiers had hyperprolactinemia, while two had GH deficiency, one ACTH deficiency, and one combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism.
Interpretation
We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate-severe bTBI, which was more frequent than in a matched group of civilian moderate-severe nbTBI. We recommend that all patients with moderate-severe bTBI should routinely have comprehensive assessment of endocrine function. ANN NEUROL 2013. © 2013 American Neurological Association.
Reference
Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, Hellyer PJ, Patel MC, Bennett AN, Mistlin A, McGilloway E, Midwinter M, Goldstone AP. Pituitary dysfunction after blast traumatic brain injury: UK BIOSAP study. Ann Neurol. 2013 Jun 22. doi: 10.1002/ana.23958. [Epub ahead of print]
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