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This version published online on September 6, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-0504
A more recent version of this article appeared on November 1, 2005
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Submitted on March 8, 2005
Accepted on August 18, 2005

Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study

Gianluca Aimaretti, Maria Rosaria Ambrosio, Carolina Di Somma, Maurizio Gasperi, Salvatore Cannavò, Carla Scaroni, Alessandra Fusco, Patrizia Del Monte, Ernesto De Menis, Marco Faustini-Fustini, Franco Grimaldi, Francesco Logoluso, Paola Razzore, Silvia Rovere, Salvatore Benvenga, Ettore Ciro degli Uberti, Laura De Marinis, Gaetano Lombardi, Franco Mantero, Enio Martino, Giulio Giordano, and Ezio Ghigo*

Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin; Department of Biomedical Sciences and Advanced Therapies, Section of Endocrinology, University of Ferrara, Ferrara; Departments of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II°, Naples; Department of Endocrinology and Metabolism, University of Pisa, Pisa; Department of Medicine and Pharmacology - Section of Endocrinology, University of Messina, Messina; Division of Endocrinology, Department of Surgical and Medical Sciences, University of Padua, Padua; Division of Endocrinology, Catholic University, Rome; Division of Endocrinology, Galliera Hospital, Genova; Service of Endocrinology, Treviso Hospital, Treviso; Division of Endocrinology, Bellaria Hospital, Bologna; Division of Endocrinology, S. Maria della Misericordia Hospital, Udine; Division of Endocrinology, University of Bari; Division of Endocrinology, S, Croce e Carle Hospital, Cuneo; Italian Society of Endocrinology, Chairman of the Study group on Physiopathology of GH secretion

* To whom correspondence should be addressed. E-mail: ezio.ghigo{at}unito.it.

Context. Traumatic Brain Injury (TBI) and Subarachnoid Hemorrhage (SAH) are conditions at high risk to develop hypopituitarism.

Objectives. 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 months evaluation had shown hypopituitarism (H) in 32.8%. Pan (PH), multiple (MH) and isolated (IH) H 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 while MH and IH was 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 months retesting. In SAH, the 3 months 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. While no MH was confirmed at 12 months, 2 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 GHD.

Conclusion. There is high risk for H in TBI and SAH patients. Early diagnosis of PH is always confirmed on 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 neuro-endocrine follow-up over time.
Key words: hypopituitarism • traumatic brain injury • subarachnoid haemorrhage




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