scholarly journals Experience of a Pituitary Clinic for US Military Veterans With Traumatic Brain Injury

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Jonathan Lee ◽  
Lindsey J Anderson ◽  
Dorota Migula ◽  
Kevin C J Yuen ◽  
Lisa McPeak ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Care Center ◽  
Hormone Replacement ◽  
Tertiary Care ◽  
Puget Sound ◽  
Symptom Burden ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Dysfunction

Abstract Context Traumatic brain injury (TBI) is considered the “signature” injury of veterans returning from wartime conflicts in Iraq and Afghanistan. While moderate/severe TBI is associated with pituitary dysfunction, this association has not been well established in the military setting and in mild TBI (mTBI). Screening for pituitary dysfunction resulting from TBI in veteran populations is inconsistent across Veterans Affairs (VA) institutions, and such dysfunction often goes unrecognized and untreated. Objective This work aims to report the experience of a pituitary clinic in screening for and diagnosis of pituitary dysfunction. Methods A retrospective analysis was conducted in a US tertiary care center of veterans referred to the VA Puget Sound Healthcare System pituitary clinic with a history of TBI at least 12 months prior. Main outcome measures included demographics, medical history, symptom burden, baseline hormonal evaluation, brain imaging, and provocative testing for adrenal insufficiency (AI) and adult-onset growth hormone deficiency (AGHD). Results Fatigue, cognitive/memory problems, insomnia, and posttraumatic stress disorder were reported in at least two-thirds of the 58 patients evaluated. Twenty-two (37.9%) were diagnosed with at least one pituitary hormone deficiency, including 13 (22.4%) AI, 12 (20.7%) AGHD, 2 (3.4%) secondary hypogonadism, and 5 (8.6%) hyperprolactinemia diagnoses; there were no cases of thyrotropin deficiency. Conclusion A high prevalence of chronic AI and AGHD was observed among veterans with TBI. Prospective, larger studies are needed to confirm these results and determine the effects of hormone replacement on long-term outcomes in this setting.

scholarly journals Hypothalamo-Pituitary Dysfunction in Patients With Chronic Subdural Hematoma

2012 ◽  
pp. 161-167 ◽  
Author(s):  
V. HÁNA ◽  
M. KOSÁK ◽  
V. MASOPUST ◽  
D. NETUKA ◽  
Z. LACINOVÁ ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Severity ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Dysfunction ◽  
One Year

Relatively frequent pituitary hormone deficiencies are observed after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) and according to the published studies the neuroendocrine consequenses of traumatic brain injury are underdiagnosed. In a cohort of 59 patients (49 males, mean age 68.3 years, 36-88 years) after evacuation of subdural hematoma (SDH) were evaluated hypothalamo-pituitary functions one week after surgery, after three months and after one year. Hypogonadism was present in 26 % of patients in an acute phase, but in the majority had a transient character. Less than half of patients was GH deficient (GHD) according to the GHRH+arginine test. We did not find any serious case of hypocortisolism, hypothyroidism, diabetes insipidus centralis nor syndrome of inappropriate secretion of ADH (SIADH). Transient partial hypocortisolism was present in two cases, but resolved. We did not find relation between extension of SDH or clinical severity and development of hypopituitarism. In conclusion, in some patients with SDH growth hormone deficiency or hypogonadism was present. No serious hypocortisolism, hypothyroidism, diabetes insipidus nor SIADH was observed. The possibility of neuroendocrine dysfunction should be considered in patients with SDH, although the deficits are less frequent than in patients after TBI or SAH.

Lasting Pituitary Hormone Deficiency after Traumatic Brain Injury

2012 ◽  
Vol 29 (1) ◽  
pp. 81-89 ◽  
Author(s):  
Odile Kozlowski Moreau ◽  
Edwige Yollin ◽  
Emilie Merlen ◽  
Walter Daveluy ◽  
Marc Rousseaux
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Pituitary Hormone Deficiency

scholarly journals Acute and Chronic Posterior Pituitary Insufficiency Among Traumatic Brain Injury Patients at a Tertiary Care Center

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A623-A623
Author(s):  
Imtiyaz Ahmad Bhat ◽  
Moomin Hussain Bhat ◽  
Shariq Rashid Masoodi ◽  
Javid Ahmad Bhat ◽  
Zafar A Shah ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Diabetes Insipidus ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Posterior Pituitary ◽  
Urinary Osmolality ◽  
Pituitary Dysfunction

Abstract Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Disorders of salt and water balance are the most commonly recognized medical complications in the immediate post-TBI period and contribute to early morbidity and mortality. Objective: We aimed to evaluate the prevalence of acute (during hospital stay) and chronic posterior pituitary dysfunction in patients of head injury admitted at our tertiary care hospital. Study Design: Prospective, Observational study. Participants: 136 patients, attending tertiary care in North India with TBI with radiological evidence of head injury. Methodology: The severity of brain injury was assessed by the Glasgow Coma Scale (GCS), and Modified Rankin Scale (MRS) score at the time of admission. Lab measurements, apart from routine CBC and biochemical tests, included tests of serum and urinary osmolality, serum sodium, cortisol, and thyroid function test during the hospital stay. All patients were monitored closely during the hospital stay. Surviving patients were evaluated at 3, 6, and 12 months of follow-up. Urinary output and water deprivation tests were done to determine chronic posterior pituitary dysfunction. The results were compared against normative data obtained from 25 matched, healthy controls. Serum & urinary osmolality was measure by the freezing point method. Diabetes insipidus (DI) and Syndrome of inappropriate ADH secretion (SIADH) were diagnosed according to standard criteria. Results: Of 136 patients admitted, 61 (44.85%) had a mild head injury (GCS, ≤8), 47 (35.55%) had a moderate injury (GCS, 9-12), and 27 (19.85%) had a severe injury (GCS, 13-15). DI occurred in 10 patients (7.4%), while SIADH was observed in 4 patients in the immediate TBI period. Risk factors for diabetes insipidus were GCS of ≤ 8 at admission, midline shift, and surgical intervention. DI was an independent risk factor for death. There was a negative correlation between the presence of DI and GCS score (r, -0.367). Most of the patients with DI (8 out of 10) died during the hospital stay. One patient persisted to have partial diabetes insipidus and another one SIADH at three months post-TBI; both patients had recovered at six months of follow-up. No new case of DI or SIADH occurred on the follow up to 12 months. Conclusion: The incidence of acute DI in severe head injury (GCS ≤ 8) could be an indicator of the severity of TBI, and associated with increased mortality as most of our patients died during the hospital stay.

scholarly journals Growth Hormone Deficiency Following Traumatic Brain Injury

2019 ◽  
Vol 20 (13) ◽  
pp. 3323 ◽  
Author(s):  
Oratile Kgosidialwa ◽  
Osamah Hakami ◽  
Hafiz Muhammad Zia-Ul-Hussnain ◽  
Amar Agha
Keyword(s):  
Traumatic Brain Injury ◽  
Growth Hormone ◽  
Brain Injury ◽  
Growth Hormone Deficiency ◽  
Dynamic Testing ◽  
Recombinant Human Growth Hormone ◽  
Chronic Phase ◽  
Hormone Deficiency ◽  
Pituitary Hormone

Traumatic brain injury (TBI) is fairly common and annually affects millions of people worldwide. Post traumatic hypopituitarism (PTHP) has been increasingly recognized as an important and prevalent clinical entity. Growth hormone deficiency (GHD) is the most common pituitary hormone deficit in long-term survivors of TBI. The pathophysiology of GHD post TBI is thought to be multifactorial including primary and secondary mechanisms. An interplay of ischemia, cytotoxicity, and inflammation post TBI have been suggested, resulting in pituitary hormone deficits. Signs and symptoms of GHD can overlap with those of TBI and may delay rehabilitation/recovery if not recognized and treated. Screening for GHD is recommended in the chronic phase, at least six months to a year after TBI as GH may recover in those with GHD in the acute phase; conversely, it may manifest in those with a previously intact GH axis. Dynamic testing is the standard method to diagnose GHD in this population. GHD is associated with long-term poor medical outcomes. Treatment with recombinant human growth hormone (rhGH) seems to ameliorate some of these features. This review will discuss the frequency and pathophysiology of GHD post TBI, its clinical consequences, and the outcomes of treatment with GH replacement.

scholarly journals 198 Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource-Poor Setting

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 253-253
Author(s):  
Jessica C Eaton ◽  
Asma Bilal Hanif ◽  
Gift Mulima ◽  
Chifundo Kajombo ◽  
Anthony Charles
Keyword(s):  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Total Mortality ◽  
Resource Poor Setting ◽  
Trauma Patients ◽  
Therapeutic Procedure ◽  
Burr Holes

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Low- and middle-income countries (LMICs) suffer from a high incidence of and mortality from TBI. Computed tomography (CT) scan is the diagnostic method of choice, but is often inaccessible in LMICs, where exploratory burr holes (EBH) remain a necessary diagnostic and therapeutic procedure. We sought to describe indications and outcomes of patients undergoing EBH at our sub-Saharan African tertiary care center. METHODS We performed a retrospective review of prospectively collected data at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs who underwent EBH were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. Because there was no neurosurgeon on staff in 2011, no patients underwent EBH. We performed logistic regression to identify predictors of mortality in the total population of TBI patients. RESULTS >241 patients presented to KCH with TBI requiring higher-level care, with a total mortality of 16.4% (Table 1). 163 (68%) underwent EBH. Of patients that underwent EBH, 87.6% of patients had intraoperative findings, with subdural hematoma being the most common (51.2%). Mortality in patients who underwent EBH was 6.8%. In surviving patients who underwent exploratory burr hole, 71.1% had a favorable outcome, defined as good recovery or moderate disability on the Glasgow Outcome Scale. Mortality in patients that did not undergo EBH was 43.9%. Upon logistic regression adjusted for age, sex, and Glasgow Coma Score, not undergoing EBH significantly increased the odds of mortality (OR = 12.0, P = 0.000, 95% CI = 4.48-31.9). CONCLUSION EBH remain an important diagnostic and therapeutic procedure for TBI in LMICs. In low-resource settings, EBH technique should be incorporated into general surgery education to attenuate TBI-related mortality.

scholarly journals Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

2010 ◽  
Vol 29 (5) ◽  
pp. E3 ◽  
Author(s):  
Andrew P. Carlson ◽  
Pedro Ramirez ◽  
George Kennedy ◽  
A. Robb McLean ◽  
Cristina Murray-Krezan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
High Resource ◽  
Interhospital Transfer ◽  
Neurosurgical Intervention

Object Patients with mild traumatic brain injury (mTBI) only rarely need neurosurgical intervention; however, there is a subset of patients whose condition will deteriorate. Given the high resource utilization required for interhospital transfer and the relative infrequency of the need for intervention, this study was undertaken to determine how often patients who were transferred required intervention and if there were factors that could predict that need. Methods The authors performed a retrospective review of cases involving patients who were transferred to the University of New Mexico Level 1 trauma center for evaluation of mTBI between January 2005 and December 2009. Information including demographic data, lesion type, need for neurosurgical intervention, and short-term outcome was recorded. Results During the 4-year study period, 292 patients (age range newborn to 92 years) were transferred for evaluation of mTBI. Of these 292 patients, 182 (62.3%) had an acute traumatic finding of some kind; 110 (60.4%) of these had a follow-up CT to evaluate progression, whereas 60 (33.0%) did not require a follow-up CT. In 15 cases (5.1% overall), the patients were taken immediately to the operating room (either before or after the first CT). Only 4 patients (1.5% overall) had either clinical or radiographic deterioration requiring delayed surgical intervention after the second CT scan. Epidural hematoma (EDH) and subdural hematoma (SDH) were both found to be significantly associated with the need for surgery (OR 29.5 for EDH, 95% CI 6.6–131.8; OR 9.7 for SDH, 95% CI 2.4–39.1). There were no in-hospital deaths in the series, and 97% of patients were discharged with a Glasgow Coma Scale score of 15. Conclusions Most patients who are transferred with mTBI who need neurosurgical intervention have a surgical lesion initially. Only a very small percentage will have a delayed deterioration requiring surgery, with EDH and SDH being more concerning lesions. In most cases of mTBI, triage can be performed by a neurosurgeon and the patient can be observed without interhospital transfer.

scholarly journals Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Sarwar Malik ◽  
Zareen Kiran ◽  
Muhammad Owais Rashid ◽  
Minaz Mawani ◽  
Asma Gulab ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Empty Sella ◽  
University Hospital ◽  
Imaging Data ◽  
Empty Sella Syndrome ◽  
Secondary Hypothyroidism

Objective: Data regarding the etiology, clinical and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan. Methods: We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between January 2004 and December 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria. Results: Forty-two patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty-seven patients (88.1%) were females. Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate. Conclusions: Non-traumatic hypopituitarism was more common in women, with Sheehan syndrome being the most common cause of hypopituitarism in our study (35.7%). Secondary hypothyroidism was the most common hormonal deficiency. The most commonly reported symptom was weakness. doi: https://doi.org/10.12669/pjms.35.4.174 How to cite this:Malik S, Kiran Z, Rashid MO, Mawani M, Gulab A, Masood MQ, et al. Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.174 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals A PROSPECTIVE STUDY OF TRAUMATIC BRAIN INJURY (TBI) AT TERTIARY CARE CENTER

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Govind Mangal ◽  
Uday Bhaumik ◽  
Gaurav Varnwal ◽  
Giriraj Prajapati
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Care Center ◽  
Tertiary Care ◽  
Study Group ◽  
Age Group ◽  
Trauma Injury ◽  
A Prospective Study ◽  
Traffic Rules

Background: Worldwide, traumatic brain injury (TBI) is the single largest cause of death and disability following injury. Most TBI’s are due to road side accidents. According to WHO data, by the year 2020, head trauma will be third largest killer in the developing world. Methods: The present study was conducted in Department of Neurosurgery. The study group consisted of a total of 200 head injury patients presenting to the Trauma center and admitted in neurosurgery ward. Results: Out of 200 cases maximum case(40.00%) were from 21-30 year age group and minimum case(3.00%) were from 0-10 year age group. 81.00% were male and 19.00% were female. Only 21.00% patients managed by surgical treatment. Conclusion: The lack of awareness among the pedestrians and disregard for traffic rules by the motorists were important reasons for most of the accidents. Keywords: Neurosurgery, Trauma, Injury.

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