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Brain injury from trauma or hemorrhage may cause pituitary hormone deficiencies
The background of the study. Brain injury from trauma or hemorrhage from a cerebral-artery aneurysm may cause pituitary hormone deficiencies, but they may be difficult to identify because of neurologic and psychiatric dysfunction. In this study, the frequency and time of onset of hypopituitarism after these two types of brain injury were summarized from the literature.
How the study was done. Nineteen studies describing the results of evaluation of hypothalamic–pituitary function in 1137 patients with traumatic brain injury (14 studies, 1015 patients) or aneurysmal hemorrhage (5 studies, 122 patients) were identified. The spectrum of neurologic deficit ranged from none to deep coma.
Most of the studies were done 3 to 36 months after the acute event. Corticotropin (ACTH), gonadotropin (follicle-stimulating hormone/luteinizing hormone [FSH/LH]), and thyrotropin (TSH) deficiency were defined on the basis of clinical manifestations and hormone measurements, and growth hormone (GH) secretion was assessed by provocative tests.
The results of the study. The frequency of one or more anterior pituitary hormone deficiencies five or more months after the acute event varied from 4 to 12 percent in the trauma group and 6 to 20 percent in the hemorrhage group. Among the deficiencies, growth hormone deficiency was the most common and hypothyroidism the least common. The frequency of one or more anterior pituitary hormone deficiencies correlated with the severity of brain injury.
Among the patients tested during the acute phase or at three months and then again at 12 months, the major change was a decrease in the frequency of gonadotropin deficiency. At 12 months, 113 patients no longer had one previously present deficiency and 50 patients had a new deficiency.
The conclusions of the study. One or more anterior pituitary hormone deficiencies may occur after traumatic brain injury or aneurysmal hemorrhage. The deficiencies may be transient or permanent, and their onset acute or delayed.
The original article. Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA 2007;298:1429-38.
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
