Journal of Rehabilitation Medicine 51-4inkOmslag | Page 30
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