2
|
Bensalah M, Donaldson M, Labassen M, Cherfi L, Nebbal M, Haffaf EM, Abdennebi B, Guenane K, Kemali Z, Ould Kablia S. Prevalence of hypopituitarism and quality of life in survivors of post-traumatic brain injury. Endocrinol Diabetes Metab 2020; 3:e00146. [PMID: 32704567 PMCID: PMC7375098 DOI: 10.1002/edm2.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 04/08/2020] [Accepted: 04/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hypopituitarism is a recognized sequela of traumatic brain injury (TBI) and may worsen the quality of life (QoL) in survivors. AIMS To assess the prevalence of post-traumatic hypopituitarism (PTHP) and growth hormone deficiency (GHD), and determine their correlation with QoL. METHODS Survivors of moderate to severe TBI were recruited from two Algerian centres. At 3 and 12 months, pituitary function was evaluated using insulin tolerance test (ITT), QoL by growth hormone deficiency in adults' questionnaire (QoL-AGHDA), and 36-item short-form (SF-36) health survey. RESULTS Of 133 (M: 128; F: 5) patients aged 18-65 years, PTHP and GHD were present at 3 and 12 months in 59 (44.4%) and 23 (17.29%), 41/116 (35.3%) and 18 (15.5%). Thirteen patients with GHD at 3 months tested normally at 12 months, while 9 had become GHD at 12 months. At 3 and 12 months, peak cortisol was < 500 nmol/L) in 39 (29.3%) and 29 (25%) patients, but <300 nmol/L in only five and seven. Prevalence for gonadotrophin deficiency was 6.8/8.6%, hypo- and hyperprolactinaemia 6.8/3.8% and 5.2/8.6%, and thyrotrophin deficiency 1.5/0.9%. Mean scores for QoL-AGHDA were higher in patients with PTHP at 3 and 12 months: 7.07 vs 3.62 (P = .001) and in patients with GHD at 12 months: 8.72 vs 4.09 (P = .015). Mean SF-36 scores were significantly lower for PTHP at 3 months. CONCLUSION Prevalence of PTHP and GHD changes with time. AGHDA measures QoL in GHD more specifically than SF-36. Full pituitary evaluation and QoL-AGHDA 12 months after TBI are recommended.
Collapse
Affiliation(s)
| | | | - Malek Labassen
- Endocrinology UnitCentral Hospital of ArmyAlgiersAlgeria
| | - Lyes Cherfi
- Critical Care UnitCentral Hospital of ArmyAlgiersAlgeria
| | | | | | | | - Kamel Guenane
- Critical care UnitSalim Zemirli HospitalAlgiersAlgeria
| | - Zahra Kemali
- Endocrinology UnitCentral Hospital of ArmyAlgiersAlgeria
| | | |
Collapse
|
3
|
Emelifeonwu JA, Flower H, Loan JJ, McGivern K, Andrews PJD. Prevalence of Anterior Pituitary Dysfunction Twelve Months or More following Traumatic Brain Injury in Adults: A Systematic Review and Meta-Analysis. J Neurotrauma 2019; 37:217-226. [PMID: 31111791 DOI: 10.1089/neu.2018.6349] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The objective of this study is to systematically review clinical studies that have reported on the prevalence of chronic post-traumatic brain injury anterior pituitary dysfunction (PTPD) 12 months or more following traumatic brain injury (TBI). We searched Medline, Embase, and PubMed up to April 2017 and consulted bibliographies of narrative reviews. We included cohort, case-control, and cross-sectional studies enrolling at least five adults with primary TBI in whom at least one anterior pituitary axis was assessed at least 12 months following TBI. We excluded studies in which other brain injuries were indistinguishable from TBI. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) score. We also considered studies that determined growth hormone deficiency and adrenocorticotrophic hormone reserve using provocation test to be at low risk of bias. Data were extracted by four independent reviewers and assessed for risk of bias using a data extraction form. We performed meta-analyses using random effect models and assessed heterogeneity using the I2 index. We identified 58 publications, of which 29 (2756 participants) were selected for meta-analysis. Twelve of these were deemed to be at low risk of bias and therefore "high-quality," as they had NOS scores greater than 8 and had used provocation tests. The overall prevalence of at least one anterior pituitary hormone dysfunction for all 29 studies was 32% (95% confidence interval [CI] 25-38%). The overall prevalence in the 12 high-quality studies was 34% (95% CI 27-42%). We observed significant heterogeneity that was not solely explained by the risk of bias. Studies with a higher proportion of participants with mild TBI had a lower prevalence of PTPD. Our results show that approximately one-third of TBI sufferers have persistent anterior pituitary dysfunction 12 months or more following trauma. Future research on PTPD should differentiate between mild and moderate/severe TBI.
Collapse
Affiliation(s)
- John A Emelifeonwu
- Department of Neurosurgery, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom.,Center for Clinical Brain Sciences, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom
| | - Hannah Flower
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie J Loan
- Department of Neurosurgery, NHS Lothian Western General Hospital, Edinburgh, United Kingdom
| | - Kieran McGivern
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Peter J D Andrews
- Center for Clinical Brain Sciences, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom
| |
Collapse
|
4
|
Klose M, Stochholm K, Janukonyté J, Christensen LL, Cohen AS, Wagner A, Laurberg P, Christiansen JS, Andersen M, Feldt-Rasmussen U. Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism. Eur J Endocrinol 2015; 172:753-62. [PMID: 25766045 DOI: 10.1530/eje-14-1069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/12/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. DESIGN AND METHODS We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue (MFI-20) were completed in parallel to pituitary assessment. RESULTS Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. CONCLUSIONS Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.
Collapse
Affiliation(s)
- Marianne Klose
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Kirstine Stochholm
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jurgita Janukonyté
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Louise Lehman Christensen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Arieh S Cohen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Aase Wagner
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Peter Laurberg
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Jens Sandahl Christiansen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Marianne Andersen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical EndocrinologyPE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, DenmarkDepartment of Internal Medicine and EndocrinologyAarhus University Hospital, Aarhus, DenmarkDepartment of Medical EndocrinologyOdense University Hospital, Odense, DenmarkClinical Mass Spectrometry UnitSection for Newborn Screening and Hormone Analysis, Department of Clinical Biochemistry, Statens Serum InstitutNeuroradiologic UnitDepartment of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DenmarkDepartment of Medical EndocrinologyAalborg University Hospital, Aalborg, Denmark
| |
Collapse
|