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. 2013 Oct;74(4):527-36.
doi: 10.1002/ana.23958. Epub 2013 Sep 24.

Pituitary Dysfunction After Blast Traumatic Brain Injury: The UK BIOSAP Study

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Free PMC article

Pituitary Dysfunction After Blast Traumatic Brain Injury: The UK BIOSAP Study

David Baxter et al. Ann Neurol. .
Free PMC article

Abstract

Objective: Pituitary dysfunction is a recognized consequence of traumatic brain injury (TBI) that causes cognitive, psychological, and metabolic impairment. Hormone replacement offers a therapeutic opportunity. Blast TBI (bTBI) from improvised explosive devices is commonly seen in soldiers returning from recent conflicts. We investigated: (1) the prevalence and consequences of pituitary dysfunction following moderate to severe bTBI and (2) whether it is associated with particular patterns of brain injury.

Methods: Nineteen male soldiers with moderate to severe bTBI (median age = 28.3 years) and 39 male controls with moderate to severe nonblast TBI (nbTBI; median age = 32.3 years) underwent full dynamic endocrine assessment between 2 and 48 months after injury. In addition, soldiers had structural brain magnetic resonance imaging, including diffusion tensor imaging (DTI), and cognitive assessment.

Results: Six of 19 (32.0%) soldiers with bTBI, but only 1 of 39 (2.6%) nbTBI controls, had anterior pituitary dysfunction (p = 0.004). Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency, and 1 had combined GH/ACTH/gonadotrophin deficiency. DTI measures of white matter structure showed greater traumatic axonal injury in the cerebellum and corpus callosum in those soldiers with pituitary dysfunction than in those without. Soldiers with pituitary dysfunction after bTBI also had a higher prevalence of skull/facial fractures and worse cognitive function. Four soldiers (21.1%) commenced hormone replacement(s) for hypopituitarism.

Interpretation: We reveal a high prevalence of anterior pituitary dysfunction in soldiers suffering moderate to severe bTBI, which was more frequent than in a matched group of civilian moderate to severe nbTBI subjects. We recommend that all patients with moderate to severe bTBI should routinely have comprehensive assessment of endocrine function.

Figures

FIGURE 1
FIGURE 1
Prevalence of pituitary dysfunction in nonblast traumatic brain injury (nbTBI) and blast TBI (bTBI). Greater prevalence of anterior pituitary dysfunction was seen in subjects after bTBI (right) than nbTBI (left). No subjects had thyroid-stimulating hormone deficiency or diabetes insipidus. ACTH = adrenocorticotropic hormone; GH = growth hormone; Gn = gonadotrophin.
FIGURE 2
FIGURE 2
Pituitary dysfunction and white matter damage in blast traumatic brain injury. Lower fractional anisotropy was seen in a priori white matter tract regions of interest in soldiers with pituitary dysfunction after blast traumatic brain injury (black, n = 6) compared to those without pituitary dysfunction (white, n = 13). Data are expressed as mean ± standard deviation. *p < 0.05 (unpaired t test). Ant = anterior; CC = corpus callosum; Cap = capsule; Int = internal; Post = posterior; WM = white matter.

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