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Blast Traumatic Brain Injury as a Cause of Pituitary Dysfunction

Summary and Comment |
January 21, 2014

Blast Traumatic Brain Injury as a Cause of Pituitary Dysfunction

  1. Jaime Toro, MD

A study in soldiers demonstrates anterior pituitary dysfunction with cognitive and emotional impairment after blast traumatic brain injury.

  1. Jaime Toro, MD

Hypopituitarism caused by traumatic brain injury (TBI) was first reported in 1918, only 4 years after the description of hypopituitarism. Blast traumatic brain injury (bTBI) is seen often after the use of improvised explosive devices like those used in Iraq, Afghanistan, and other countries involved in military conflict. Pituitary dysfunction with associated cognitive, psychological, and metabolic impairment is recognized frequently after TBI, but the prevalence after bTBI is unknown.

In this study, researchers recruited 19 military bTBI patients from the Academic Department of Military Emergency Medicine trauma database (Birmingham, U.K.). These patients, along with 39 civilian controls with moderate-to-severe nonblast TBI, underwent a full endocrine assessment.

Six of the 19 soldiers with bTBI (32%) had anterior pituitary dysfunction. Two soldiers had hyperprolactinemia, 2 had growth hormone (GH) deficiency, 1 had adrenocorticotropic hormone (ACTH) deficiency and 1 had combined GH/ACTH/gonadotrophin deficiency. Only 1 of the 39 controls (2.6%) had anterior pituitary dysfunction. Greater traumatic axonal brain injury in the cerebellum and corpus callosum was apparent in diffusion tensor magnetic resonance imaging of soldiers with pituitary dysfunction compared to those without. Soldiers with pituitary dysfunction after bTBI had a higher prevalence of skull fractures and more cognitive dysfunction than those without pituitary dysfunction.

Comment

Neuroendocrine dysfunction after traumatic brain injury may have a much higher prevalence than previously suspected. The prevalence of endocrine dysfunction in all clinical studies of TBI ranges from 15% to 68% (JAMA 2007; 298:1429). As the authors note, there seems to be a specific TBI pattern associated with a blast, but the mechanism of brain injury caused by a blast is unclear. This is the most definitive study to date demonstrating a high prevalence of anterior pituitary hormone abnormalities after a moderate-to-severe bTBI. Patients with this type of injury should always have a comprehensive assessment of endocrine function.

  • Disclosures for Jaime Toro, MD at time of publication Editorial boards Multiple Sclerosis and Related Disorders

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