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J Rehabil Med 2019; 51: 264–272 ORIGINAL REPORT IMPACT OF PITUITARY DYSFUNCTION ON COGNITIVE AND GLOBAL OUTCOME AFTER TRAUMATIC BRAIN INJURY AND ANEURYSMAL SUBARACHNOID HAEMORRHAGE Anna TÖLLI, MD, PhD 1 , Charlotte HÖYBYE, MD, PhD 2 , Bo-Michael BELLANDER, MD, PhD 3 and Jörgen BORG, MD, PhD 1 From the 1 Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 2 Department of Molecular Medicine and Surgery, Karolinska Institutet and Patient Area Endocrinology and Nephrology, Inflammation and Infection Theme, Karolinska University Hospital and 3 Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden Objective: To explore associations between pituitary dysfunction and clinical outcome at 12 months after traumatic brain injury and aneurysmal subarachnoid haemorrhage. Methods: Prospective cohort study of 82 patients with traumatic brain injury and 45 with aneurysmal suba- rachnoid haemorrhage, included at one neurointensi- ve care unit. Baseline data comprised age, sex, Glas- gow Coma Scale (GCS) score, S100B and pupil light reactions. Hormone data were collected in the neu- rointensive care unit and after 3, 6 and 12 months. Outcome was assessed with Barrow Neurological In- stitute Screen for Higher Cerebral Functions (BNIS), Rancho Los Amigos Cognitive Scale-Revised (RLAS- R) and Glasgow Outcome Scale Extended (GOSE). Results: The most frequent hormonal deviations were hypogonadotropic hypogonadism (38%) and hypercortisolism (52%). At 12 months, performan- ce on BNIS was impaired in 54% and GOSE in 37%. Controlling for baseline variables, low levels of go- nadal hormones were associated with lower GOSE score (b = –0.80, p  = 0.033), high levels of prolactin with lower RLAS (b = –1.42, p  = 0.034) and high le- vels of serum insulin-like growth factor I (S-IGF-I) with lower RLAS level (b = –1.78, p  = 0.002) and lo- wer GOSE score (b = –1.49, p  = 0.006). Conclusion: These data suggest that pituitary dys- functions during the first year after traumatic brain injury and aneurysmal subarachnoid haemorrhage may have clinically relevant, independent effects on clinical outcome at 12 months. Key words: traumatic brain injury; subarachnoid haemorr- hage; outcome; pituitary dysfunction. Accepted Jan 29, 2019; Epub ahead of print Feb 14, 2019 J Rehabil Med 2019; 51: 264–272 Correspondence address: Anna Tölli, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 182 88 Stockholm, Sweden. E-mail: [email protected] P ituitary dysfunction (PiD) following traumatic brain injury (TBI) has been subject to several studies. A systematic review by Lauzier et al. in 2014 (1) concluded that approximately one-third of patients with TBI will develop at least 1 anterior pituitary disor- der, and that older age, TBI severity and skull fractures LAY ABSTRACT Traumatic brain injury and aneurysmal subarachnoid haemorrhage are leading causes of physical, cognitive and behavioural disabilities. Traumatic brain injury and aneurysmal subarachnoid haemorrhage may affect the hypothalamus and pituitary gland, which are of major importance for our hormone balance. The purpose of the study was to investigate the relationship between the pituitary dysfunction after traumatic brain injury and aneurysmal aneurysmal subarachnoid haemorrhage, and cognitive and global outcomes at 12 months after the injury. In total, we included 127 patients during neuroin- tensive care. Follow-up was at a rehabilitation medicine department. The study showed negative associations between high level of growth hormone and prolactin and behavioural and cognitive function; and between low go- nadotropins and high prolactin and global outcome. We conclude that some pituitary dysfunctions during the first year after traumatic brain injury and aneurysmal suba- rachnoid haemorrhage may have clinically relevant, in- dependent effects on clinical outcome at 12 months. are risk factors for PiD. They pointed out the need for further studies to clarify the clinical impact of PiD after TBI to guide systematic screening for PiD after TBI. Corresponding studies of PiD following aneurysmal subarachnoid haemorrhage (aSAH) were reviewed by Robba et al. in 2016 (2). They concluded that approx- imately half of patients with aSAH exhibit PiD in the acute phase and one-quarter in the chronic phase, and that surgical treatment of the aneurysm and age had an impact on the prevalence of PiD after aSAH. As for TBI, the impact of PiD on clinical outcome after aSAH remains to be clarified. Both TBI and aSAH may cause a wide range of disabilities (3, 4), as often assessed by global measures, such as the Glasgow Outcome Scale (GOS) (5) or the extended version (GOSE) (6). Cognitive impairments are common after both TBI (7, 8) and aSAH (4) and global measures may not be sensitive enough to cap- ture these. While comprehensive neuropsychological testing is demanding, some studies have used screening methods, such as the Montreal Cognitive Assessment (9) or the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) (10), to describe This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2531 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977