PMID- 26413767
OWN - NLM
STAT- MEDLINE
DCOM- 20160824
LR  - 20210503
IS  - 1557-9042 (Electronic)
IS  - 0897-7151 (Linking)
VI  - 32
IP  - 22
DP  - 2015 Nov 15
TI  - Predictors of Hypopituitarism in Patients with Traumatic Brain Injury.
PG  - 1789-95
LID - 10.1089/neu.2015.3998 [doi]
AB  - Hypopituitarism may often occur in association with traumatic brain injury (TBI). 
      Identification of reliable predictors of pituitary dysfunction is of importance 
      in order to establish a rational testing approach. We searched the records of 
      patients with TBI, who underwent neuroendocrine evaluation in our institution 
      between 2007 and 2013. One hundred sixty-six adults (70% men) with TBI (median 
      age: 41.6 years; range: 18-76) were evaluated at a median interval of 40.4 months 
      (0.2-430.4).Of these, 31% had >/=1 pituitary deficiency, including 29% of patients 
      with mild TBI and 35% with moderate/severe TBI. Growth hormone deficiency was the 
      most common deficiency (21%); when body mass index (BMI)-dependent cutpoints were 
      used, this was reduced to 15%. Central hypoadrenalism occurred in10%, who were 
      more likely to have suffered a motor vehicle accident (MVA, p = 0.04), 
      experienced post-traumatic seizures (p = 0.04), demonstrated any intracranial 
      hemorrhage (p = 0.05), petechial brain hemorrhages (p = 0.017), or focal cortical 
      parenchymal contusions (p = 0.02). Central hypothyroidism occurred in 8% and 
      central hypogonadism in 12%; the latter subgroup had higher BMI (p = 0.03), were 
      less likely to be working after TBI (p = 0.002), and had lower Global Assessment 
      of Functioning (GAF) scores (p = 0.03). Central diabetes insipidus (DI) occurred 
      in 6%, who were more likely to have experienced MVA (p < 0.001) or sustained 
      moderate/severe TBI (p < 0.001). Patients with MVA and those with post-traumatic 
      seizures, intracranial hemorrhage, petechial brain hemorrhages, and/or focal 
      cortical contusions are at particular risk for serious pituitary dysfunction, 
      including adrenal insufficiency and DI, and should be referred for neuroendocrine 
      testing. However, a substantial proportion of patients without these risk factors 
      also developed hypopituitarism.
FAU - Silva, Paula P B
AU  - Silva PP
AD  - 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General 
      Hospital and Harvard Medical School , Boston, Massachusetts.
FAU - Bhatnagar, Saurabha
AU  - Bhatnagar S
AD  - 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation 
      Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, 
      Massachusetts.
FAU - Herman, Seth D
AU  - Herman SD
AD  - 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation 
      Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, 
      Massachusetts.
FAU - Zafonte, Ross
AU  - Zafonte R
AD  - 2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation 
      Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, 
      Massachusetts.
FAU - Klibanski, Anne
AU  - Klibanski A
AD  - 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General 
      Hospital and Harvard Medical School , Boston, Massachusetts.
FAU - Miller, Karen K
AU  - Miller KK
AD  - 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General 
      Hospital and Harvard Medical School , Boston, Massachusetts.
FAU - Tritos, Nicholas A
AU  - Tritos NA
AD  - 1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General 
      Hospital and Harvard Medical School , Boston, Massachusetts.
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20150929
PL  - United States
TA  - J Neurotrauma
JT  - Journal of neurotrauma
JID - 8811626
RN  - 12629-01-5 (Human Growth Hormone)
SB  - IM
MH  - Accidents, Traffic
MH  - Adolescent
MH  - Adrenal Insufficiency/etiology
MH  - Adult
MH  - Aged
MH  - Body Mass Index
MH  - Brain Hemorrhage, Traumatic/etiology/pathology
MH  - Brain Injuries/*complications/pathology
MH  - Cerebral Cortex/pathology
MH  - Diabetes Insipidus
MH  - Female
MH  - Human Growth Hormone/deficiency
MH  - Humans
MH  - Hypogonadism/etiology/pathology
MH  - Hypopituitarism/*etiology/pathology
MH  - Hypothyroidism/etiology/pathology
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Seizures/etiology
MH  - Tomography, X-Ray Computed
MH  - Young Adult
OTO - NOTNLM
OT  - adrenal insufficiency
OT  - diabetes insipidus
OT  - growth hormone deficiency
OT  - hypogonadism
OT  - hypopituitarism
OT  - hypothyroidism
OT  - traumatic brain injury
EDAT- 2015/09/29 06:00
MHDA- 2016/08/25 06:00
CRDT- 2015/09/29 06:00
PHST- 2015/09/29 06:00 [entrez]
PHST- 2015/09/29 06:00 [pubmed]
PHST- 2016/08/25 06:00 [medline]
AID - 10.1089/neu.2015.3998 [doi]
PST - ppublish
SO  - J Neurotrauma. 2015 Nov 15;32(22):1789-95. doi: 10.1089/neu.2015.3998. Epub 2015 
      Sep 29.