Acute anterior pituitary dysfunction in patients presenting to the emergency department with a mild traumatic brain injury
EANS Academy. Flower H. 09/27/19; 276100; EP05010
Ms. Hannah Flower
Ms. Hannah Flower

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Background: The importance of anterior pituitary insufficiency following traumatic brain injury (TBI) remains contested. There is little data concerning the prevalence of pituitary insufficiency in patients presenting to the emergency department (ED) with a mild TBI.
Methods: Patients presenting to the ED with a mild TBI (Glasgow Coma Scale 13-15) were screened for anterior pituitary insufficiency; fasting morning (between 8am and 10am) hormone levels of cortisol, free thyroxine, TSH, IGF-1 and sex hormones were checked within 7 days of injury.
Results: A total of 37 patients completed anterior pituitary hormone screening. Fourteen patients (38%) had an anterior pituitary dysfunction. Eleven patients (30%) had one anterior pituitary axis abnormality (73% of these had a sex hormone deficiency) and 3 patients (8%) had deficiencies in 2 axes. Only 3 of the 14 had a 'complex' mild TBI as determined by positive finding of brain injury on CT scan (Marshall score ≥2).
Conclusion: We found a high prevalence of anterior pituitary dysfunction within the first week of injury in patients that suffered a mild TBI. Hormone dysfunction was not related to positive CT imaging findings. Further analyses are required to determine which patients go on to develop long-standing (chronic) anterior pituitary insufficiencies.
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