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Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study
David Baxter1, David J Sharp, Claire Feeney
1Computational Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London, Hammersmith Hospital, London; Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham.
Annals of Neurology
|June 25, 2013
Summary
Blast traumatic brain injury (bTBI) significantly increases the risk of pituitary dysfunction in soldiers. Early endocrine assessment is crucial for managing cognitive and metabolic impairments following bTBI.
Area of Science:
- Neuroendocrinology
- Traumatology
- Military Medicine
Background:
- Traumatic brain injury (TBI) can lead to pituitary dysfunction, impacting cognitive, psychological, and metabolic functions.
- Blast TBI (bTBI), often caused by improvised explosive devices, is prevalent in soldiers returning from conflict zones.
- Hormone replacement therapy is a potential treatment for TBI-induced endocrine deficits.
Purpose of the Study:
- To determine the prevalence and consequences of pituitary dysfunction in soldiers with moderate to severe bTBI.
- To investigate the association between pituitary dysfunction and specific brain injury patterns after bTBI.
- To compare pituitary dysfunction rates between bTBI and non-blast TBI (nbTBI) populations.
Main Methods:
- Endocrine assessment of 19 male soldiers with moderate to severe bTBI and 39 male controls with moderate to severe nbTBI.
- Structural brain MRI, including diffusion tensor imaging (DTI), and cognitive assessments were performed on soldiers.
- Hormone levels were assessed between 2 and 48 months post-injury.
Main Results:
- Anterior pituitary dysfunction was found in 32.0% of bTBI soldiers versus 2.6% of nbTBI controls (p = 0.004).
- Pituitary dysfunction included hyperprolactinemia, growth hormone (GH) deficiency, adrenocorticotropic hormone (ACTH) deficiency, and combined deficiencies.
- bTBI patients with pituitary dysfunction showed greater white matter injury in the cerebellum and corpus callosum, higher rates of skull/facial fractures, and worse cognitive function.
Conclusions:
- Soldiers with moderate to severe bTBI exhibit a high prevalence of anterior pituitary dysfunction, significantly exceeding that in civilian nbTBI patients.
- Pituitary dysfunction after bTBI is linked to specific patterns of brain injury and poorer cognitive outcomes.
- Routine comprehensive endocrine function assessment is recommended for all patients with moderate to severe bTBI.
