Chronic hypopituitarism after traumatic brain injury and replacement therapy

Objective To investigate themorbidity of chronic pituitary hormone deficiency and the efficacy of replacement therapy in patients with traumatic brain injury. Methods Total 120 patients with chronic sequelae of cerebral trauma were enrolled and assessed at 6 and 12 months after injury for hormonal function.Major hormonal deficiencies,including GH,ACTH,TSH,LH/FSH and ADH deficiencies,were identified.The clinical data and CT imaging data were analyzed.The general and acute injury characteristics were compared in patients with and without hypopituitarism by the use of multivariate logistic analysis.In addition,GH replacement for hypopituitarism patients was conducted,and the efficacy was assessment. Results Out of 120 patients tested at 12 months after injury,the incidence of GH,ACTH,TSH,LH/FSH and ADH deficiency was 19.2%,3.3%,0%,12.5% and 1.7%,respectively.As compared to 6 months after injury,there was no different for GH deficiency,however,other hormonal deficiencies were a certain degree of recovered.Compared with the non-hypopituitarism patients,hypopituitarism patients had higher BMI,hypoxia rate,diffuse brain swelling,evacuated intracranial hemorrhage rate and computed tomography score(P＜0.05).The multivariate logistic model revealed that BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.In addition,compared with the pre-treatment value,hypopituitarism patients had better LCFS,DRS and FIM scores after GH replacement therapy. Conclusions The incidences of GH and LH/FSH deficiency were high for patients after traumatic brain injury;BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.GH replacement for hypopituitarism patients was useful for their recovery.