Thyrotropin and other pituitary hormone
deficiencies may occur after head trauma or bleeding
(November 2004)
The background of the study. Head trauma and bleeding
into the subarachnoid space are known causes of hypopituitarism,
but pituitary function has rarely been systematically tested in
patients who survived either. In this study hypothalamic–pituitary
function was tested systematically in groups of these patients.
How the study was done. The study groups consisted
of 100 patients (mean age, 37 years) who had sustained a head injury
and 40 patients (mean age, 51 years) who had sustained a subarachnoid
hemorrhage from a ruptured aneurysm. Three months after discharge
from the intensive-care unit, the patients were studied for corticotropin
(ACTH), thyrotropin (TSH), follicle-stimulating and luteinizing
hormone (FSH and LH), growth hormone (GH), and antidiuretic hormone
(ADH) deficiency.
The results of the study. Thirty-five of the 100
patients with head injuries (35 percent) had at least one pituitary
hormone deficiency, of whom 4 percent, 6 percent, and 25 percent,
respectively, had complete, multiple, and single deficiencies (Table).
All the patients with thyroid deficiency and 87.5 percent of those
with adrenal deficiency had other deficiencies.
Fifteen of the 40 patients with a subarachnoid hemorrhage (37.5
percent) had one or more pituitary hormone deficiencies (Table).
None had complete hypopituitarism, 10 percent had multiple deficiencies,
and 27.5 percent had single deficiencies.
The conclusions of the study. Patients who sustain
a head injury or subarachnoid hemorrhage may have one or more pituitary
hormone deficiencies three months later.
The original article. Aimaretti G, Ambrosio MR,
Di Somma C, Fusco A, Cannavo S, Gasperi M, Scaroni C, De Marinis
L, Benvenga S, degli Uberti EC, Lombardi G, Mantero F, Martino E,
Giordano G, Ghigo E. Traumatic brain injury and subarachnoid haemorrhage
are conditions at high risk for hypopituitarism: screening study
at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004;61:320-6.
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