Long term pituitary function, functional- and patient reported outcomes in severe acquired brain injury

Abstract Objective Assessment of post-traumatic hypothalamic-pituitary dysfunctions is expected to be most relevant to offer patients with severe intracranial affection. We aimed to investigate the prevalence of hypopituitarism in patients with severe acquired traumatic (TBI) compared with non-traumatic (NTBI) brain injury, and to relate pituitary insufficiency to functional and patient-reported outcomes. Design Prospective Methods We included patients admitted for inpatient neurorehabilitation after severe TBI (N=48) and NTBI (N=18). The patients underwent pituitary function assessment at mean 2.4 years after the injury. Functional outcome was assessed by Functional Independence Measure and Glasgow Outcome Scale-Extended (both one year after discharge from neurorehabilitation) and patient-reported outcome by Multiple Fatigue Inventory (MFI-20) and EQ-5D-3L. Results Hypopituitarism was seen in 10/42 (24%) TBI patients, and 7/18 (39%) NTBI patients, P= 0.23. Insufficiencies affected 1 axis in 14/17 (82%) patients (13 hypogonadotropic hypogonadism, 1 GH deficiency), at 2 axes in 3/17 (18%) patients (1 hypogonadotropic hypogonadism and GH deficiency, 2 hypogonadotropic hypogonadism and ADH deficiency). None had central hypoadrenalism or central hypothyroidism. In both TBI and NTBI patients, pituitary status was unrelated to functioning and ability scores at one year, and to patient-reported outcome scores mean 2.4 years after the injury. Conclusion Patients with severe acquired brain injury may develop long-term hypothalamus-pituitary insufficiency, with an equal occurrence in TBI and NTBI patients. In both cases, mainly isolated deficiencies, most commonly affecting the gonadal axis were seen. Insufficiencies were unrelated to functional outcomes and patient-reported outcomes probably reflecting the complexity and heterogeneous manifestations in both patient groups.