Structured assessment of neuroendocrine dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage in 1112 patients – the German interdisciplinary database

Aims: Recent studies show that traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) are frequent causes of long-term disturbances of hypothalamo-pituitary function. Still, little is known about risk factors and clinical characteristics of pituitary impairment after brain damage. This study aims to address these questions on a larger scale by establishing a national registry of these patients. Methods: Several large trauma centers in Germany treating patients with TBI or SAH and performing endocrine assessments include patients in this on-going investigation. Data are collected using a structured, internet-based study sheet, obtaining information on clinical, radiological and hormonal parameters. Results: To date, 1112 patients (725 TBI, age 43.5±19.7 years; 378 SAH, 49.7±11.8 years) have been included. Stimulation tests for the corticotropic and somatotropic axes were performed in 26% and 22% of the patients, respectively. In patients with known pituitary function, hypopituitarism was reported in 28% and 27% after TBI and SAH, respectively. According to the frequency of impairment, pituitary hormone secretion was impaired the following sequence: ACTH, LH/FSH, GH, and TSH. Conclusions: Our data confirm that hypopituitarism is a common complication of TBI and SAH, also when using data obtained from a large and unselected patient cohort. However, we can not exclude a certain selection bias for performing endocrine stimulation tests only in more severely traumatized patients.