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

IF 5.3 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

European Journal of Endocrinology Pub Date : 2024-05-02 DOI:10.1093/ejendo/lvae047

Djordje Marina, Ulla Feldt-Rasmussen, Marianne Klose

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Abstract

Objective: Assessment of posttraumatic hypothalamic-pituitary dysfunctions is expected to be the most relevant assessment to offer patients with severe intracranial affection. In this study, we aim to investigate the prevalence of hypopituitarism in patients with severe acquired traumatic brain injury (TBI) compared with nontraumatic brain injury (NTBI) and to relate pituitary insufficiency to functional and patient-reported outcomes.

Design: This is a prospective study.

Methods: We included patients admitted for inpatient neurorehabilitation after severe TBI (N = 42) and NTBI (N = 18). The patients underwent a pituitary function assessment at a mean of 2.4 years after the injury. Functional outcome was assessed by using Functional Independence Measure and Glasgow Outcome Scale-Extended (both 1 year after discharge from neurorehabilitation) and patient-reported outcome was assessed by using Multiple Fatigue Inventory-20 and EQ-5D-3L.

Results: Hypopituitarism was reported in 10/42 (24%) patients with TBI and 7/18 (39%) patients with NTBI (P = .23). Insufficiencies affected 1 axis in 14/17 (82%) patients (13 hypogonadotropic hypogonadism and 1 growth hormone [GH] deficiency) and 2 axes in 3/17 (18%) patients (1 hypogonadotropic hypogonadism and GH deficiency, and 2 hypogonadotropic hypogonadism and arginin vasopressin deficiency). None had central hypoadrenalism or central hypothyroidism. In patients with both TBI and NTBI, pituitary status was unrelated to functioning and ability scores at 1 year and to patient-reported outcome scores at a mean of 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 patients with TBI and NTBI. In both types of patients, 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.

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严重后天性脑损伤患者的长期垂体功能、功能性结果和患者报告结果。

目的：创伤后下丘脑-垂体功能障碍的评估预计与严重颅内损伤患者的病情最为相关。我们旨在调查严重获得性创伤（TBI）与非创伤性（NTBI）脑损伤患者垂体功能减退的发生率，并将垂体功能不全与功能和患者报告的结果联系起来：设计：前瞻性：我们纳入了严重创伤性脑损伤（48 例）和非创伤性脑损伤（18 例）后住院接受神经康复治疗的患者。患者在受伤后平均2.4年接受垂体功能评估。功能结果由功能独立性量表和格拉斯哥结果量表扩展版（均在神经康复出院一年后）进行评估，患者报告结果由多重疲劳量表（MFI-20）和EQ-5D-3L进行评估：10/42（24%）名创伤性脑损伤患者和7/18（39%）名非创伤性脑损伤患者出现垂体功能减退，P= 0.23。14/17（82%）名患者的一个轴受到影响（13 例性腺功能减退，1 例 GH 缺乏），3/17（18%）名患者的两个轴受到影响（1 例性腺功能减退和 GH 缺乏，2 例性腺功能减退和 ADH 缺乏）。没有人患有中枢性肾上腺功能减退症或中枢性甲状腺功能减退症。在创伤性脑损伤和非创伤性脑损伤患者中，垂体状态与伤后一年的功能和能力评分无关，也与伤后2.4年患者报告的平均结果评分无关：结论：严重后天性脑损伤患者可能会出现长期的下丘脑-垂体功能不全，在创伤性脑损伤和非创伤性脑损伤患者中发生率相同。在这两种病例中，主要是孤立的下丘脑-垂体功能不全，最常见的是影响性腺轴。下丘脑-垂体功能不全与功能结果和患者报告的结果无关，这可能反映了两组患者的复杂性和异质性表现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Endocrinology 医学-内分泌学与代谢

CiteScore

9.80

自引率

3.40%

发文量

354

审稿时长

1 months

期刊介绍： European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.