Hypopituitarism after Severe Traumatic Brain Injury, an observational study

Traumatic brain injury (TBI) is one of the most important causes of disability
and mortality in western countries. In the Netherlands about 30.000 mainly
young people are annually diagnosed with traumatic brain injury. At least
300.000 people are thought to have had traumatic brain injury in the past. 1
Sequelae from traumatic brain injury result in a reduced quality of life for
the patient and his or her environment and also high costs for society.
Hypopituitarism, or deficiency of one or more pituitary hormones, is a known
complication of traumatic brain injury. The posterior pituitary lobe often
shows transient loss of function, whereas the anterior pituitary lobe often has
permanent loss of function. In recent years a lot of research has been done
regarding the prevalence of hypopituitarism after TBI. There seems to be a time
dependent loss of function. The pituitary function of patients who develop
hypopituitarism in the acute phase (within 3 months after TBI) will sometimes
normalize in the chronic phase after TBI, but also new cases will occur in the
chronic phase. 2,3,4,5 These recent studies show that hypopituitarism after TBI
is a more frequent complication than thought before, found in about 25-30% of
patients with severe head trauma. 6,7,8,9
A lot of the persisting cognitive, physical and emotional complaints and
deficits after TBI are thought to be caused by a post-contusion or
post-traumatic syndrome. These problems could however also be caused by
hypopituitarism. Symptoms of hypopituitarism can be difficult to recognize in
this patient population and as recent research has shown, hypopituitarism
appears to be an underestimated problem.
Treatment with hormones is easy once hypopituitarism is diagnosed and could
lead to a significant improvement of neuro-psychological and physical
performance of these patients.

Bone structure and strength depend on mechanical loading, adequate nutrition
and hormonal balances. No research has been done on the incidence of
osteoporosis in patients with traumatic brain injury, although they are at
increased risk for developing osteoporosis. Most patients are immobilized and
institutionalized with lack of sun exposition and as mentioned above there
seems to be an increased incidence of hypopituitarism. Furthermore nutritional
deficiency, medication and autonomic dysfunction can cause loss of bone mass. 10


References;

1 Mazaux JM, Richer E. Rehabilitation after traumatic brain injury in adults.
Disabil Rehabil;1998;20(12):435-47.
2 Aimaretti G, Ambrosio MR, di Somma C, Gasperi M, Cannavo S, et al. Residual
pituitary function after brain injury-induced hypopituitarism: A prospective
12-month study. J Clin Endocrinol Metab 2005;90:6085-6092
3 Agha A, Phillips J, O*Kelly P, Tormey W, Thompson CJ. The natural history of
posttraumatic hypopituitarism: Implications for assessment and treatment. Am J
Med 2005; 118:1416e1-1416e7
4 Tanriverdi F, Senyurek H, Unluhizarci K, Selcuklu A, Casanueva FF, et al.
High risk of
hypopituitarism after brain injury: A prospective investigation of anterior
pituitary function in the acute phase and 12 months after trauma. J Clin
endocrinol Metab 2006;91:2105-2111
5 Schneider HJ, Schneider M, Saller B, Petersenn S, Husemann B, et al.
Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic
brain injury. Eur J Endocrinol. 154:259-265
6 Agha A, Rogers B, Sherlock M, O*Kelly, Tormey W, et al. Anterior pituitary
dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab
2004;89:4929-4936
7 Aimeretti A, Ambrosio MR, di Somma C, Fusco A, Cannavo S, et al. Traumatic
brain injury and subarachnoid haemorrhage are conditions at high risk for
hypopituitarism: screening study at 3 months after brain injury. Clin
Endocrinol 2004; 61: 20-326
8 Leal-Cerro A, Florest JM, Rincont M, Murillot F, Pujol M, et al. Prevalence
of hypopituitarism and growth hormone deficiency in adults long-term after
severe traumatic brain injury. Clin Endocrinol 2005;62:525-532
9 Lieberman S, Oberoi AL, Gilikson CR, Masel BE, Urban RJ. Prevalence of
neuroendocrine
dysfunction in patients recovering from traumatic brain injury. J Clin
Endocrinol Metab 2001; 86:2752-2756
10 van der Poest Clement E. Postfracture bone loss and its prevention. Thesis
VUMC, the Netherlands november 2004

To study the prevalence of hypopituitarism and osteoporosis in patients 5 tot
10 years after severe traumatic brain injury

Cross-sectional observational study

The burden consists of coming to the poliklinic, having an interview and
fysical examination. Furthermore participation in a questionair, undergoing an
ultrasound of the healbone, bone density measurement and bloodtest. If the
bloodtest shows signs of hormone deficiency adittional tests are necesarry to
examine the function of the pituitary gland.
There are no significant risks attached to participating in the study. There
are however possible benefits for participants. Hypopituitarism and
osteoporosis are easy to treat. Hormone supplements in hypopituitarism can
improve cognitive, fysical and neuro-psychological performance. Treatment of
osteoporosis can prevent fractures and bone deformation.