IMPACT OF PITUITARY DYSFUNCTION ON COGNITIVE AND GLOBAL OUTCOME AFTER TRAUMATIC BRAIN INJURY AND ANEURYSMAL SUBARACHNOID HAEMORRHAGE

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 subarachnoid haemorrhage, included at one neurointensive care unit. Baseline data comprised age, sex, Glas-gow Coma Scale (GCS) score, 51008 and pupil light reactions. Hormone data were collected in the neurointensive care unit and after 3, 6 and 12 months. Outcome was assessed with Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Rancho Los Amigos Cognitive Scale-Revised (RLASR) and Glasgow Outcome Scale Extended (GOSE). Results: The most frequent hormonal deviations were hypogonadotropic hypogonadism (38%) and hypercortisolism (52%). At 12 months, performance on BNIS was impaired in 54% and GOSE in 37%. Controlling for baseline variables, low levels of gonadal 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 levels of serum insulin-like growth factor I (S-IGF-I) with lower RLAS level (b = -1.78, p = 0.002) and lower GOSE score (b = -1.49, p = 0.006). Conclusion: These data suggest that pituitary dysfunctions during the first year after traumatic brain injury and aneurysmal subarachnoid haemorrhage may have clinically relevant, independent effects on clinical outcome at 12 months.