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Residual Pituitary Function after Brain Injury-Induced Hypopituitarism: A Prospective 12-Month Study

Division of Endocrinology and Metabolism (G.A., S.R., E.G.), Department of Internal Medicine, University of Turin, 10126 Turin, Italy; Department of Biomedical Sciences and Advanced Therapies (M.R.A., E.C.d.U.), Section of Endocrinology, University of Ferrara, 44100 Ferrara, Italy; Departments of Molecular and Clinical Endocrinology and Oncology (C.D.S., G.L.), University of Naples Federico IIø, 80138 Naples, Italy; Department of Endocrinology and Metabolism (M.G., E.M.), University of Pisa, 56127 Pisa, Italy; Department of Medicine and Pharmacology (S.C., S.B.), Section of Endocrinology, University of Messina, 98100 Messina, Italy; Division of Endocrinology (C.S., F.M.), Department of Surgical and Medical Sciences, University of Padua, 35122 Padua, Italy; Division of Endocrinology (A.F., L.D.M.), Catholic University, 00168 Rome, Italy; Division of Endocrinology (P.D.M.), Galliera Hospital, 16128 Genova, Italy; Service of Endocrinology (E.D.M.), Treviso Hospital, 31100 Treviso, Italy; Division of Endocrinology (M.F.-F.), Bellaria Hospital, 40139 Bologna, Italy; Division of Endocrinology (F.G.), S. Maria della Misericordia Hospital, 33100 Udine, Italy; Division of Endocrinology (F.L.), University of Bari, 70126 Bari, Italy; Division of Endocrinology (P.R.), S. Croce e Carle Hospital, 12100 Cuneo, Italy; and Italian Society of Endocrinology (G.G.), Chairman of the Study Group on Physiopathology of GH Secretion

Address all correspondence and requests for reprints to: Ezio Ghigo, M.D., Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, University of Turin, C.so Dogliotti, 14, 10126 Turin, Italy. E-mail: ezio.ghigo{at}unito.it.

Context: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are conditions at high risk for the development of hypopituitarism.

Objective: The objective of the study was to clarify whether pituitary deficiencies and normal pituitary function recorded at 3 months would improve or worsen at 12 months after the brain injury.

Design and Patients: Pituitary function was tested at 3 and 12 months in patients who had TBI (n = 70) or SAH (n = 32).

Results: In TBI, the 3-month evaluation had shown hypopituitarism (H) in 32.8%. Panhypopituitarism (PH), multiple (MH), and isolated (IH) hypopituitarism had been demonstrated in 5.7, 5.7, and 21.4%, respectively. The retesting demonstrated some degree of H in 22.7%. PH, MH, and IH were present in 5.7, 4.2, and 12.8%, respectively. PH was always confirmed at 12 months, whereas MH and IH were confirmed in 25% only. In 5.5% of TBI with no deficit at 3 months, IH was recorded at retesting. In 13.3% of TBI with IH at 3 months, MH was demonstrated at 12-month retesting. In SAH, the 3-month evaluation had shown H in 46.8%. MH and IH had been demonstrated in 6.2 and 40.6%, respectively. The retesting demonstrated H in 37.5%. MH and IH were present in 6.2 and 31.3%, respectively. Although no MH was confirmed at 12 months, two patients with IH at 3 months showed MH at retesting; 30.7% of SAH with IH at 3 months displayed normal pituitary function at retesting. In SAH, normal pituitary function was always confirmed. In TBI and SAH, the most common deficit was always severe GH deficiency.

Conclusion: There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed in the long term. Pituitary function in brain-injured patients may improve over time but, although rarely, may also worsen. Thus, brain-injured patients must undergo neuroendocrine follow-up over time.

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