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High Risk of Hypogonadism After Traumatic Brain Injury: Clinical Implications

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Abstract

Several recent studies have convincingly documented a close association between traumatic brain injury (TBI) and pituitary dysfunction. Post-traumatic hypogonadism is very common in the acute post-TBI phase, though most cases recover within six to twelve months following trauma. The functional significance of early hypogonadism, which may reflect adaptation to acute illness, is not known. Hypogonadism persists, however, in 10–17% of long-term survivors. Sex steroid deficiency has implications beyond psychosexual function and fertility for survivors of TBI. Muscle weakness may impair functional recovery from trauma and osteoporosis may be exacerbated by immobility secondary to trauma. Identification and appropriate and timely management of post-traumatic hypogonadism is important in order to optimise patient recovery from head trauma, improve quality of life and avoid the long-term adverse consequences of untreated sex steroid deficiency.

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Abbreviations

TBI::

traumatic brain injury

LH::

luteinizing hormone

FSH::

follicle-stimulating hormone

GnRH::

gonadotropin-releasing hormone

References

  1. Klasbeek WD, McLaurin RL, Harris BSH, Miller JD. The national head and spinal cord survey findings. J Neurosurg 1980;53:519–531.

    Google Scholar 

  2. Van Baalen B, Odding E, Maas AIR, Ribbers GM, Bergen MP, Stam HJ. Traumatic brain injury: Classification of initial severity and determination of functional outcome. Disabil Rehabil 2003;25:9–18.

    CAS  PubMed  Google Scholar 

  3. Masel BE. Rehabilitation and hypopituitarism after traumatic brain injury. Growth Horm IGF Res 2004;14:S108–S113.

    PubMed  Google Scholar 

  4. Kelly DF, Gonzalo ITW, Cohan P, Berman N, Swerdloff R, Wang C. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: A preliminary report. J Neurosurg 2000;93:743–752.

    CAS  PubMed  Google Scholar 

  5. Lieberman SA, Oberoi AL, Gilkinson CR, Masel BE, Urban RJ. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 2001;86:2752–2756.

    Article  CAS  PubMed  Google Scholar 

  6. Agha A, Roger B, Mylotte D, Taleb F, Tormey W, Phillips J, Thompson CJ. Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clin Endocrinol (Oxf) 2004;60:584–591.

    CAS  Google Scholar 

  7. Agha A, Rogers B, Sherlock M, Tormey W, Phillips J, Thompson CJ. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 2004;89:4929–4936.

    CAS  PubMed  Google Scholar 

  8. Bondanelli M, DE Marinis L, Ambrosio MR, Monesi M, Valle D, Zatelli MC, Fusco A, Bianchi A, Farneti M, degli Uberti EC. Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 2004;21:685–696.

    Article  PubMed  Google Scholar 

  9. Aimaretti G, Ambrosio MR, Di Somma C, Fusco A, Cannavo S, Gasperi M, Scaroni C, De Marinis L, Benvenga S, Uberti ECD, Lombardi G, Mantero F, Martino E, Giordano G, Ghigo E. Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: Screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004;61:320–326.

    Article  CAS  Google Scholar 

  10. Popovic V, Pekic S, Pavlovic D, Maric N, Jasovic-Gasic M, Djurovic B, Medic Stojanoska M, Zivkovic V, Stojanovic M, Doknic M, Milic N, Djurovic M, Dieguez C, Casanueva FF. Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress. J Endocrinol Invest 2004;27:1048–1054.

    CAS  PubMed  Google Scholar 

  11. Benvenga S, Vigo T, Ruggeri RM, Lapa D, Almoto B, LoGiudice F, Longo M, Blandino A, Campenni A, Cannavo S, Trimarchi F. Severe head trauma in patients with unexplained central hypothyroidism. Am J Med 2004;116:767–771.

    Article  PubMed  Google Scholar 

  12. Leal-Cerro A, Flores JM, Rincon M, Murillo F, Pujol M, Garcia-Pesquera F, Dieguez C, Casanueva FF. Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury. Clin Endocrinol (Oxf) 2005;62:525–532.

    Article  CAS  Google Scholar 

  13. Levitan D, Moser SA, Goldstein DA, Kletzky OA, Lobo RA, Massry SG. Disturbances in the hypothalamic-pituitary-gonadal axis in male patients with acute renal failure. Am J Nephrol 1984;4:99–106.

    CAS  PubMed  Google Scholar 

  14. Spratt DI, Bigos ST, Beitins I, Cox P, Longcope C, Orav J. Both hyper- and hypogonadotrophic hypogonadism occur transiently in acute illness: Bio- and immunoreactive gonadotrophins. J Clin Endocrinol Metab 1992;75:1562–1570.

    Article  CAS  PubMed  Google Scholar 

  15. Van den Berghe G. Endocrine evaluation of patients with critical illness. Endocrinol Metab Clin North Am 2003;32:385–410.

    CAS  PubMed  Google Scholar 

  16. Rudman D, Fleischer AS, Kutner MH, Raggio JF. Suprahypophyseal hypogonadism and hypothyroidism during prolonged coma after head trauma. J Clin Endocrinol Metab 1977;45:747–754.

    CAS  PubMed  Google Scholar 

  17. Woolf PD, Hamill RW, McDonald JV, Lee LA, Kelly M. Transient hypogonadotrophic hypogonadism after head trauma : Effects on steroid precursors and correlation with sympathetic nervous system activity. Clin Endocrinol (Oxf) 1986;25:265–274.

    CAS  Google Scholar 

  18. Fleischer AS, Rudman DR, Payne NS, Tindall GT. Hypothalamic hypothyroidism and hypogonadism in prolonged traumatic coma. J Neurosurg 1978;49:650–657.

    CAS  PubMed  Google Scholar 

  19. Hackl JM, Gottardis M, Wieser Ch, Rumpl E, Stadler Ch, Schwartz S, Monkayo R. Endocrine abnormalities in severe traumatic brain injury- a cue to prognosis in severe craniocerebral trauma? Intensive Care Med 1991;17:25–29.

    Article  CAS  PubMed  Google Scholar 

  20. Cernak I, Savic VJ, Lazarov A, Joksimovic M, Markovic S. Neuroendocrine responses following graded traumatic brain injury in male adults. Brain Inj 1999;13:1005–1015.

    CAS  PubMed  Google Scholar 

  21. Lee S, Zasler ND, Kreutzer JS. Male pituitary-gonadal dysfunction following severe traumatic brain injury. Brain Inj 1994;8:571–577.

    CAS  PubMed  Google Scholar 

  22. Teasdale G, Jennet B. Assessment of coma and impaired consciousness: A practical scale. Lancet 1974;2:81–84.

    CAS  PubMed  Google Scholar 

  23. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480–485.

    CAS  PubMed  Google Scholar 

  24. Agha A, Phillips J, O’Kelly P, Tormey W, Thompson CJ. The natural history of post-traumatic hypopituitarism: Implications for assessment and treatment. Am J Med 2005 (in press).

  25. Edwards OM, Clark JDA. Post-traumatic hypopituitarism. Medicine 1986;65:281–290.

    CAS  PubMed  Google Scholar 

  26. Benvenga S, Campenni A, Ruggeri RM, Trimarchi F. Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000;85:1353–1361.

    Article  CAS  PubMed  Google Scholar 

  27. Yaun X-Q, Wade CE. Neuroendocrine abnormalities in patients with traumatic brain injury. Front Neuroendocrinol 1991;12:209–230.

    Google Scholar 

  28. Besser GM. Hypothalamic regulatory hormones: Physiological and clinical implications. Bull Schweiz Akad Med Wiss 1978;34:285–297.

    CAS  PubMed  Google Scholar 

  29. Matsuura H, Nakazawa S, Wakabahyashi I. Thyrotropin-releasing hormone provocative release of prolactin and thyrotropin in acute head injury. Neurosurgery 1985;16:791–795.

    CAS  PubMed  Google Scholar 

  30. Chiolero R, Lemarchard TH, Schutz Y, de Tribolet N, Felber JP, Free J, Jequier E. Plasma growth hormone levels in severe trauma with or without head injury. J Trauma 1988;28:1368–1374.

    CAS  PubMed  Google Scholar 

  31. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore longitudinal study of aging. J Clin Endocrinol Metab 2001;86:724–731.

    Article  CAS  PubMed  Google Scholar 

  32. Tenover JL. Male hormone replacement therapy including “andropause”. Endocrinol Metab Clin North Am 1998;27:969–987.

    Article  CAS  PubMed  Google Scholar 

  33. Clark RV. History and physical examination. Endocrinol Metab Clin North Am 1994;23:699–707.

    CAS  PubMed  Google Scholar 

  34. Dunn JF, Nisula BC, Rodbard D. Transport of steroid hormones: Binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma. J Clin Endocrinol Metab 1981;53:58–68.

    CAS  PubMed  Google Scholar 

  35. Winters SJ. Endocrine evaluation of testicular function. Endocrinol Metab Clin North Am 1994;23:709–723.

    CAS  PubMed  Google Scholar 

  36. Kiningham RB, Apgar BS, Schwenk TL. Evaluation of amenorrhea. Am Fam Physician 1996;53:1185–1194.

    CAS  PubMed  Google Scholar 

  37. Pavord SR, Girach A, Price DE, Absalom SR, Falconer-Smith J, Howlett TA. A retrospective audit of the combined pituitary function test, using the insulin stress test, TRH and GnRH in a district laboratory. Clin Endocrinol(Oxf) 1992;36:135–139.

    CAS  Google Scholar 

  38. Burke CW. The pituitary megatest: Outdated? Clin Endocrinol (Oxf) 1992;36:133–134.

    CAS  Google Scholar 

  39. Westood ME, Butler GE, McLellan AC, Barth JH. The combined pituitary function test in children: An evaluation of the clinical usefulness of TRH and LHRH stimulation tests through a retrospective analysis of one hundred and twenty six cases. Clin Endocrinol (Oxf) 2000;52:727–735.

    Google Scholar 

  40. Lanfranco F, Kamischke A, Zitzmann M, Nieschlag E. Klinefelter's syndrome. Lancet 2004;364:273–283.

    Article  CAS  PubMed  Google Scholar 

  41. Breuil V, Euller-Ziegler L. Gonadal dysgenesis and bone metabolism. Joint Bone Spine 2001;68:26–33.

    Article  CAS  PubMed  Google Scholar 

  42. Kalantaridou SN, Davis SR, Nelson LM. Premature ovarian failure. Endocrinol Metab Clin North Am 1998;27:989–1006.

    Article  CAS  PubMed  Google Scholar 

  43. Tomlinson JW, Holden N, Hills RK, Wheatley K, Clayton RN, Bates AS, Sheppard MC, Stewart PM, and the West Midland Prospective Hypopituitary Study Group. Association between premature mortality and hypopituitarism. Lancet 2001;357:425–431.

    Article  CAS  PubMed  Google Scholar 

  44. Gooren LJ, Bunck MC. Androgen replacement therapy: Present and future. Drugs 2004;64:1861–1891.

    Article  CAS  PubMed  Google Scholar 

  45. Arlt W. Management of the androgen-deficient woman. Growth Horm IGF Res 2003;13(Suppl A):S85–S89.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Academic Division of Endocrinology and Diabetes, Beaumont Hospital and RCSI Medical School, Dublin, Ireland

    Amar Agha M.D. & Christopher J. Thompson M.D.

Authors
  1. Amar Agha M.D.
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  2. Christopher J. Thompson M.D.
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Correspondence to Christopher J. Thompson M.D..

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Agha, A., Thompson, C.J. High Risk of Hypogonadism After Traumatic Brain Injury: Clinical Implications. Pituitary 8, 245–249 (2005). https://doi.org/10.1007/s11102-005-3463-4

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  • DOI: https://doi.org/10.1007/s11102-005-3463-4

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