Session: SUN 130-162-Neuroendocrinology
Poster Board SUN-146
Aim: We questioned the justification of general recommendations for assessment of hypopituitarism in patients with TBI, and aimed to describe the prevalence of hypopituitarism in a national TBI population of patients admitted to a Danish hospital in 2008, as compared to healthy controls.
Patients and Methods: We included 463 patients (18-65 years) hospitalized ≥ 24h, with more than subtle TBI as indicated by loss of consciousness, amnesia, or cranial/cerebral imaging abnormalities. The patients underwent endocrine assessment median 2.5 years (range 1.0 - 4.4) postTBI. Assessment included baseline evaluation of thyroid and gonadal hormone concentrations, and dynamic assessment of the GH and HPA axis. Results were compared to those from healthy controls. Deficiencies were defined according to local assay and test specific cut-offs.
Results: An insufficient 30 min. cortisol response to Synacthen® stimulation was more frequently seen in patients 26/344 (7.1%) than controls 0/113 (0%)(p=0.01), whereas an insufficient response to ITT was seen equally frequent in patients 9/204 (4.6%) and controls 3/116 (2.6%)(p=0.7). An insufficient GH response to PD-GHRH or GHRH-arginine was seen more often in patients 47/360 (11.6%) than controls 2/93 (2.1%)(p<0.01), whereas an insufficient peak GH to ITT was equally frequent in patients 9/200 (4.5%) and controls 2/88 (2.3%)(p=0.4). A total testosterone below the lower cut-off was seen in 32/300 (10.7%) male patients vs. 0/62 (0%) controls (p=0.01). In women, hypogonadism could not be excluded in 4/152 (2.6%) patients vs. 1/32 (3.1%) controls (p=0.9). Low free T4 was seen in 5/461 (1.1%) patients vs. 3/96 (3.1%) controls (p=0.1).
Conclusion: These preliminary results from the nationwide study of TBI patients assessed 2.5 years after the injury illustrates that the methodological approach for assessment of pituitary function is of importance when defining the prevalence of pituitary insufficiency. Hormonal responses of the various pituitary axes in TBI patients may or may not differ from what should be expected from healthy controls, and insufficiency should thus be confirmed by re-testing.
Disclosure: UF: Investigator, Novo Nordisk, Speaker, Novo Nordisk, Advisory Group Member, Pfizer Global R&D. Nothing to Disclose: MK, MA, JJ, LF, KS, PL
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
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