Pituitary Dysfunction After Blast Concussion: Imaging and Psychological Correlates

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 130-162-Neuroendocrinology
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-148
Charles W. Wilkinson*1, Eric C. Petrie1, Satoshi Minoshima2, Donna J. Cross2, Todd L. Richards2, Kathleen F. Pagulayan1 and Elaine R. Peskind1
1VA Puget Sound Health Care System, Seattle, WA, 2University of Washington, Seattle, WA
Studies of traumatic brain injury (TBI) from all causes have reported a prevalence of chronic hypopituitarism, defined by deficient production of one or more pituitary hormones measured at least one year after injury, of 25-50%. Chronic hypopituitarism is associated with a constellation of symptoms that overlaps considerably with PTSD including fatigue, anxiety, depression, sleep disorders, social isolation, aggression, sexual dysfunction, cognitive deficits, and deleterious changes in body composition and cardiovascular function. However, the prevalence of hypopituitarism after blast concussion/mild TBI (mTBI) has not previously been investigated. We measured twelve pituitary and target organ hormones in blood samples from male Veterans of deployment to Iraq or Afghanistan with mTBI (n = 36) and from male Veterans of deployment without blast exposure (n = 14). Criteria for identifying abnormal hormone levels were derived from measurement of basal hormone concentrations in healthy male non-Veteran control subjects. Subjects also underwent magnetic resonance imaging of fractional anisotropy and macromolecular proton fraction to assess brain white matter integrity; [18F]-fluorodeoxyglucose positron emission tomography imaging of cerebral glucose metabolism; structured clinical assessments of blast exposure, psychiatric diagnoses, and PTSD symptoms; neurologic evaluations; and self-report scales of postconcussive symptoms, combat exposure, depression, sleep quality, and alcohol use. Six of the initial 26 subjects with a history of blast concussion enrolled in the study were found to have hormone levels consistent with hypogonadism and/or growth hormone deficiency. Basal circulating hormone concentrations, voxelwise analyses for each of the three imaging modalities, and demographic, blast exposure, psychiatric and self-report data are presented for these six subjects and for six age-matched deployed controls. We previously found a significantly greater prevalence of anterior pituitary hormone abnormalities in the blast mTBI group than in the deployment control group and now report the imaging, neuropsychological, and behavioral characteristics of the two groups. Our findings provide support for the value of routine hormonal screening in directing diagnostic and treatment decisions that might otherwise remain unconsidered and for markedly facilitating the recovery and rehabilitation of blast-exposed Veterans.

Nothing to Disclose: CWW, ECP, SM, DJC, TLR, KFP, ERP

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: U.S. Department of Defense Congressionally Directed Medical Research Program Concept Award PT090753; Department of Veterans Affairs (VA) Rehabilitation Research and Development Service Merit Review Award; Geriatric Research, Education and Clinical Center, and Research and Development Service of the VA Puget Sound Health Care System; VA Northwest Network Mental Illness Research, Education and Clinical Center; Seattle Institute for Biomedical and Clinical Research; University of Washington Alzheimer’s Disease Research Center NIA AG05136; and an anonymous foundation.