Chronic hypopituitarism after traumatic brain injury: Risk assessment and relationship to outcome

Sumati Bavisetty, Supriya Bavisetty, David L. McArthur, Joshua R. Dusick, Christina Wang, Pejman Cohan, W. John Boscardin, Ronald Swerdloff, Harvey Levin, Dongwoo J. Chang, Jan Paul Muizelaar, Daniel F. Kelly

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Objective: Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury. We sought to define the incidence, risk factors, and neurobehavioral consequences of chronic hormonal deficiencies after complicated mild, moderate, or severe traumatic brain injury. METHODS: Patients aged 14 to 80 years were prospectively enrolled at the time of injury and assessed at 3 and 6 to 9 months after injury for hormonal function and neurobehavioral consequences. Major and minor (subclinical) hormonal deficiencies, including growth hormone deficiency (GHD) and growth hormone insufficiency (GHI), were identified. Acute injury characteristics, neurobehavioral, and quality of life measures were compared in patients with and without major hormonal deficits by the use of multivariate analysis. RESULTS: Out of 70 patients (mean age, 32 yr; median Glasgow Coma Scale score, 7; 19% women) tested at 6 to 9 months after injury, 15 (21%) had at least one major hormonal deficiency, 20 (29%) had minor deficiencies, and 30 (43%) had major and/or minor deficiencies. Patients with major deficiencies included 16% with GHD or GHI, 10.5% with hypogonadism, and 1.4% with diabetes insipidus. None of the patients required adrenal or thyroid replacement. At 6 to 9 months after injury, patients with major hormonal deficits had more abnormal acute computed tomographic findings (P = 0.014), greater acute and chronic body mass index (P < 0.01), and a worse Disability Rating Scale score (multivariate P = 0.04). Compared with the 59 growth hormone-sufficient patients, the 11 patients with GHD or GHI had worse Disability Rating Scale scores (multivariate P = 0.04), greater rates of depression, (90 versus 53%; multivariate P = 0.06), and worse quality of life in the Short Form-36 domains of energy and fatigue (multivariate P = 0.03), emotional well-being (multivariate P = 0.02), and general health (multivariate P = 0.07). CONCLUSION: Chronic hypopituitarism warranting hormone replacement occurs in approximately 20% of patients after complicated mild, moderate, or severe traumatic brain injury and is associated with more severe brain injuries and increased disability. GHD and GHI are also associated with increased disability, poor quality of life, and a greater likelihood of depression. The clinical significance of minor hormonal deficits, which occur in almost 30% of patients, warrants further study. Given that major deficiencies are readily treatable, routine pituitary hormonal testing within 6 months of injury is indicated for this patient population.

Original languageEnglish (US)
Pages (from-to)1080-1093
Number of pages14
JournalNeurosurgery
Volume62
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Hypopituitarism
Growth Hormone
Wounds and Injuries
Quality of Life
Traumatic Brain Injury
Diabetes Insipidus
Glasgow Coma Scale
Hypogonadism
Brain Injuries
Fatigue
Thyroid Gland
Body Mass Index
Multivariate Analysis
Hormones

Keywords

  • Endocrinopathy
  • Growth hormone deficiency
  • Hypopituitarism
  • Injury severity
  • Pituitary failure
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Bavisetty, S., Bavisetty, S., McArthur, D. L., Dusick, J. R., Wang, C., Cohan, P., ... Kelly, D. F. (2008). Chronic hypopituitarism after traumatic brain injury: Risk assessment and relationship to outcome. Neurosurgery, 62(5), 1080-1093. https://doi.org/10.1227/01.neu.0000325870.60129.6a

Chronic hypopituitarism after traumatic brain injury : Risk assessment and relationship to outcome. / Bavisetty, Sumati; Bavisetty, Supriya; McArthur, David L.; Dusick, Joshua R.; Wang, Christina; Cohan, Pejman; Boscardin, W. John; Swerdloff, Ronald; Levin, Harvey; Chang, Dongwoo J.; Muizelaar, Jan Paul; Kelly, Daniel F.

In: Neurosurgery, Vol. 62, No. 5, 05.2008, p. 1080-1093.

Research output: Contribution to journalArticle

Bavisetty, S, Bavisetty, S, McArthur, DL, Dusick, JR, Wang, C, Cohan, P, Boscardin, WJ, Swerdloff, R, Levin, H, Chang, DJ, Muizelaar, JP & Kelly, DF 2008, 'Chronic hypopituitarism after traumatic brain injury: Risk assessment and relationship to outcome', Neurosurgery, vol. 62, no. 5, pp. 1080-1093. https://doi.org/10.1227/01.neu.0000325870.60129.6a
Bavisetty, Sumati ; Bavisetty, Supriya ; McArthur, David L. ; Dusick, Joshua R. ; Wang, Christina ; Cohan, Pejman ; Boscardin, W. John ; Swerdloff, Ronald ; Levin, Harvey ; Chang, Dongwoo J. ; Muizelaar, Jan Paul ; Kelly, Daniel F. / Chronic hypopituitarism after traumatic brain injury : Risk assessment and relationship to outcome. In: Neurosurgery. 2008 ; Vol. 62, No. 5. pp. 1080-1093.
@article{449c5d85aebd4a2889feaed28f8e0b77,
title = "Chronic hypopituitarism after traumatic brain injury: Risk assessment and relationship to outcome",
abstract = "Objective: Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury. We sought to define the incidence, risk factors, and neurobehavioral consequences of chronic hormonal deficiencies after complicated mild, moderate, or severe traumatic brain injury. METHODS: Patients aged 14 to 80 years were prospectively enrolled at the time of injury and assessed at 3 and 6 to 9 months after injury for hormonal function and neurobehavioral consequences. Major and minor (subclinical) hormonal deficiencies, including growth hormone deficiency (GHD) and growth hormone insufficiency (GHI), were identified. Acute injury characteristics, neurobehavioral, and quality of life measures were compared in patients with and without major hormonal deficits by the use of multivariate analysis. RESULTS: Out of 70 patients (mean age, 32 yr; median Glasgow Coma Scale score, 7; 19{\%} women) tested at 6 to 9 months after injury, 15 (21{\%}) had at least one major hormonal deficiency, 20 (29{\%}) had minor deficiencies, and 30 (43{\%}) had major and/or minor deficiencies. Patients with major deficiencies included 16{\%} with GHD or GHI, 10.5{\%} with hypogonadism, and 1.4{\%} with diabetes insipidus. None of the patients required adrenal or thyroid replacement. At 6 to 9 months after injury, patients with major hormonal deficits had more abnormal acute computed tomographic findings (P = 0.014), greater acute and chronic body mass index (P < 0.01), and a worse Disability Rating Scale score (multivariate P = 0.04). Compared with the 59 growth hormone-sufficient patients, the 11 patients with GHD or GHI had worse Disability Rating Scale scores (multivariate P = 0.04), greater rates of depression, (90 versus 53{\%}; multivariate P = 0.06), and worse quality of life in the Short Form-36 domains of energy and fatigue (multivariate P = 0.03), emotional well-being (multivariate P = 0.02), and general health (multivariate P = 0.07). CONCLUSION: Chronic hypopituitarism warranting hormone replacement occurs in approximately 20{\%} of patients after complicated mild, moderate, or severe traumatic brain injury and is associated with more severe brain injuries and increased disability. GHD and GHI are also associated with increased disability, poor quality of life, and a greater likelihood of depression. The clinical significance of minor hormonal deficits, which occur in almost 30{\%} of patients, warrants further study. Given that major deficiencies are readily treatable, routine pituitary hormonal testing within 6 months of injury is indicated for this patient population.",
keywords = "Endocrinopathy, Growth hormone deficiency, Hypopituitarism, Injury severity, Pituitary failure, Traumatic brain injury",
author = "Sumati Bavisetty and Supriya Bavisetty and McArthur, {David L.} and Dusick, {Joshua R.} and Christina Wang and Pejman Cohan and Boscardin, {W. John} and Ronald Swerdloff and Harvey Levin and Chang, {Dongwoo J.} and Muizelaar, {Jan Paul} and Kelly, {Daniel F.}",
year = "2008",
month = "5",
doi = "10.1227/01.neu.0000325870.60129.6a",
language = "English (US)",
volume = "62",
pages = "1080--1093",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Chronic hypopituitarism after traumatic brain injury

T2 - Risk assessment and relationship to outcome

AU - Bavisetty, Sumati

AU - Bavisetty, Supriya

AU - McArthur, David L.

AU - Dusick, Joshua R.

AU - Wang, Christina

AU - Cohan, Pejman

AU - Boscardin, W. John

AU - Swerdloff, Ronald

AU - Levin, Harvey

AU - Chang, Dongwoo J.

AU - Muizelaar, Jan Paul

AU - Kelly, Daniel F.

PY - 2008/5

Y1 - 2008/5

N2 - Objective: Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury. We sought to define the incidence, risk factors, and neurobehavioral consequences of chronic hormonal deficiencies after complicated mild, moderate, or severe traumatic brain injury. METHODS: Patients aged 14 to 80 years were prospectively enrolled at the time of injury and assessed at 3 and 6 to 9 months after injury for hormonal function and neurobehavioral consequences. Major and minor (subclinical) hormonal deficiencies, including growth hormone deficiency (GHD) and growth hormone insufficiency (GHI), were identified. Acute injury characteristics, neurobehavioral, and quality of life measures were compared in patients with and without major hormonal deficits by the use of multivariate analysis. RESULTS: Out of 70 patients (mean age, 32 yr; median Glasgow Coma Scale score, 7; 19% women) tested at 6 to 9 months after injury, 15 (21%) had at least one major hormonal deficiency, 20 (29%) had minor deficiencies, and 30 (43%) had major and/or minor deficiencies. Patients with major deficiencies included 16% with GHD or GHI, 10.5% with hypogonadism, and 1.4% with diabetes insipidus. None of the patients required adrenal or thyroid replacement. At 6 to 9 months after injury, patients with major hormonal deficits had more abnormal acute computed tomographic findings (P = 0.014), greater acute and chronic body mass index (P < 0.01), and a worse Disability Rating Scale score (multivariate P = 0.04). Compared with the 59 growth hormone-sufficient patients, the 11 patients with GHD or GHI had worse Disability Rating Scale scores (multivariate P = 0.04), greater rates of depression, (90 versus 53%; multivariate P = 0.06), and worse quality of life in the Short Form-36 domains of energy and fatigue (multivariate P = 0.03), emotional well-being (multivariate P = 0.02), and general health (multivariate P = 0.07). CONCLUSION: Chronic hypopituitarism warranting hormone replacement occurs in approximately 20% of patients after complicated mild, moderate, or severe traumatic brain injury and is associated with more severe brain injuries and increased disability. GHD and GHI are also associated with increased disability, poor quality of life, and a greater likelihood of depression. The clinical significance of minor hormonal deficits, which occur in almost 30% of patients, warrants further study. Given that major deficiencies are readily treatable, routine pituitary hormonal testing within 6 months of injury is indicated for this patient population.

AB - Objective: Chronic pituitary dysfunction is increasingly recognized as a sequela of traumatic brain injury. We sought to define the incidence, risk factors, and neurobehavioral consequences of chronic hormonal deficiencies after complicated mild, moderate, or severe traumatic brain injury. METHODS: Patients aged 14 to 80 years were prospectively enrolled at the time of injury and assessed at 3 and 6 to 9 months after injury for hormonal function and neurobehavioral consequences. Major and minor (subclinical) hormonal deficiencies, including growth hormone deficiency (GHD) and growth hormone insufficiency (GHI), were identified. Acute injury characteristics, neurobehavioral, and quality of life measures were compared in patients with and without major hormonal deficits by the use of multivariate analysis. RESULTS: Out of 70 patients (mean age, 32 yr; median Glasgow Coma Scale score, 7; 19% women) tested at 6 to 9 months after injury, 15 (21%) had at least one major hormonal deficiency, 20 (29%) had minor deficiencies, and 30 (43%) had major and/or minor deficiencies. Patients with major deficiencies included 16% with GHD or GHI, 10.5% with hypogonadism, and 1.4% with diabetes insipidus. None of the patients required adrenal or thyroid replacement. At 6 to 9 months after injury, patients with major hormonal deficits had more abnormal acute computed tomographic findings (P = 0.014), greater acute and chronic body mass index (P < 0.01), and a worse Disability Rating Scale score (multivariate P = 0.04). Compared with the 59 growth hormone-sufficient patients, the 11 patients with GHD or GHI had worse Disability Rating Scale scores (multivariate P = 0.04), greater rates of depression, (90 versus 53%; multivariate P = 0.06), and worse quality of life in the Short Form-36 domains of energy and fatigue (multivariate P = 0.03), emotional well-being (multivariate P = 0.02), and general health (multivariate P = 0.07). CONCLUSION: Chronic hypopituitarism warranting hormone replacement occurs in approximately 20% of patients after complicated mild, moderate, or severe traumatic brain injury and is associated with more severe brain injuries and increased disability. GHD and GHI are also associated with increased disability, poor quality of life, and a greater likelihood of depression. The clinical significance of minor hormonal deficits, which occur in almost 30% of patients, warrants further study. Given that major deficiencies are readily treatable, routine pituitary hormonal testing within 6 months of injury is indicated for this patient population.

KW - Endocrinopathy

KW - Growth hormone deficiency

KW - Hypopituitarism

KW - Injury severity

KW - Pituitary failure

KW - Traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=49049088406&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49049088406&partnerID=8YFLogxK

U2 - 10.1227/01.neu.0000325870.60129.6a

DO - 10.1227/01.neu.0000325870.60129.6a

M3 - Article

C2 - 18580806

AN - SCOPUS:49049088406

VL - 62

SP - 1080

EP - 1093

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -