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Posttraumatic Hypopituitarism Is Associated with an Unfavorable Body Composition and Lipid Profile, and Decreased Quality of Life 12 Months after Injury

Department of Medical Endocrinology (M.K., T.W., U.F.-R.), University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark; and Department of Neurosurgery (J.B.), Copenhagen University Hospital Glostrup, 2600 Glostrup, Denmark

Address all correspondence and requests for reprints to: Marianne Christina Klose, M.D., Department of Medical Endocrinology, PE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E-mail: mcklose{at}hotmail.com.

Objective: Our objective was to describe body composition, lipid profile, and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) in relation to the development of posttraumatic hypopituitarism.

Design: This is a cross-sectional evaluation with a nested prospective substudy.

Patients: The cross-sectional cohort included 104 hospitalized patients with TBI [26 females/78 males; median age 41 yr (range 18–64); body mass index (BMI) 25 kg/m² (range 17–39); and severity, mild (Glasgow Coma Scale score (GCS) 13–15) n = 44, moderate (GCS 9–12) n = 20, and severe (GCS <9) n = 40)]. A nested cohort of 46 patients was followed prospectively.

Measurements: BMI, waist circumference, lipid profile, total- and regional-fat mass were assessed 3 and 12 months (prospective) or only 12 months (cross-sectional) posttraumatically. HRQL questionnaires (Nottingham Health Profile, EuroQoL-5D, and the GH deficiency (GHD) specific instrument, Quality of Life Assessment of GHD in Adults) were completed "pre-traumatically," 3 and 12 months (prospective), or only 12 months (cross-sectional) posttraumatically.

Results: Patients with posttraumatic hypopituitarism had higher age-, gender-, and BMI-adjusted 12-month low-density lipoprotein-cholesterol, waist circumference, and total fat mass (P < 0.05 in all cases), and a higher increase in total cholesterol (P = 0.01) during follow-up compared with sufficient patients. These findings were unrelated to 12-month IGF-I and IGF-I SD scores. Hypopituitary patients also had worse age, BMI, and TBI severity adjusted overall EuroQoL-5D visual analog scale (P = 0.03) and Quality of Life Assessment of GHD in Adults (P = 0.01) scores, and worse Nottingham Health Profile dimension scores of sleep (P = 0.03), energy (P = 0.02), and social isolation (P = 0.04), compared with patients with an intact pituitary function.

Conclusion: Posttraumatic hypopituitarism was an independent predictor of the classical phenotypical features of hypopituitarism, including an unfavorable lipid and body composition profile, as well as worsened HRQL.

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