Pituitary dysfunction after blast traumatic brain injury

The UK BIOSAP study

Authors

  • David Baxter MD,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
    2. Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham
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  • David J. Sharp MD, PhD,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
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  • Claire Feeney MD,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
    2. Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
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  • Debbie Papadopoulou BSc, RN,

    1. Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
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  • Timothy E. Ham MD,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
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  • Sagar Jilka BSc, MRes,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
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  • Peter J. Hellyer BSc, MRes,

    1. Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London
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  • Maneesh C. Patel BSc, MD,

    1. Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
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  • Alexander N. Bennett MD, PhD,

    1. Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey
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  • Alan Mistlin MD,

    1. Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey
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  • Emer McGilloway MD,

    1. Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey
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  • Mark Midwinter MD,

    1. Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham
    2. Academic Section for Musculoskeletal Disease, Chapel Allerton Hospital, University of Leeds, Leeds
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  • Anthony P. Goldstone MD, PhD

    Corresponding author
    1. Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
    2. Metabolic and Molecular Imaging Group, Medical Research Council Clinical Sciences Centre Imperial College London, Hammersmith Hospital, London, United Kingdom
    • Address correspondence to Dr Goldstone, Metabolic and Molecular Imaging Group, MRC Clinical Sciences Centre, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom. E-mail: tony.goldstone@imperial.ac.uk

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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. Ann Neurol 2013;74:527–536

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