Traumatic injury to the brain and endocrine evaluation of the anterior pituitary a year after the event [the TRIBE study]

ABSTRACT

Recent clinical studies have shown that moderate and severe traumatic brain injury [TBI] is a common cause of hypopituitarism. Mild TBI has also been associated with hypopituitarism, which since it is often not evaluated, the hypopituitarism may remain under diagnosed. In this study we aimed at determining the clinical and hormonal profile of mild TBI patients admitted a year after their injury. The sample was a descriptive, prospective cohort in a tertiary hospital. A hypopituitarism clinical evaluation form was used to evaluate the patients for signs and symptoms of hypopituitarism a year after mild TBI. Pituitary hormonal function was tested a year after their injury for IGF-1, FT4, TSH, cortisol, LH, FSH and testosterone. Six male patients with mild TBI were studied. Mean age 27 +/- 8 years old. All of them had intra-cranial hemorrhage on CT-scan and five underwent emergency decompressive cranial surgery. Evaluation was done 481 +/- 67 days after the event. Signs of hypopituitarism were not observed but symptoms of decreased vigor and weight gain was present in five of the six patients. IGF-1 was low in 33% [2/6] and testosterone level was low in 17% [1/6].8 am cortisol levels were equivocal in 83% [5/6] but ACTH-stimulated cortisol values were normal. Thyroid function test were normal for all subjects. The most common symptoms were weight gain and decreased vigor. Signs of hypopituitarism were not noted among the mild TBI patients. Pituitary hormone testing revealed abnormalities in the somatotrophic and gonadotrophic axes