Patient reported out-come in posttraumatic pituitary deficiency: results from The Danish National Study on Posttraumatic Hypopituitarism

OBJECTIVE: Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The study aim was to describe patient reported outcome in a national a-priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment.

DESIGN AND METHODS: We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health related quality of life (QoL)(SF36, EQ5D, QoLAGHDA) and fatigue (MFI-20) were completed in parallel to pituitary assessment.

RESULTS: Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, though only partially confirmed after adjustment for demographic differences. Hypogonadotrophic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total-testosterone (men), but not free-testosterone or any other hormone concentrations. Total-testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants and anticonvulsants.

CONCLUSIONS: Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.