Objective

Pituitary dysfunction following mild traumatic brain injury can have serious physical and psychological consequences, making correct diagnosis and treatment essential. To the best of our knowledge, this study is the first to study the prevalence of pituitary dysfunction following mild traumatic brain injury in an all-female population following detailed endocrinological work-up after screening for pituitary dysfunction in female athletes.

Design

This is a retrospective cohort study.

Methods

Hormone screening blood tests, including serum blood values for thyroid-stimulating hormone, free thyroxin, insulin-like growth factor 1, prolactin, cortisol, follicle-stimulating hormone, luteinizing hormone, estrogen and progesterone, were taken in 133 female athletes. Results were repeatedly outside the reference value in 88 women necessitating further endocrinological evaluation. Two of those were lost to follow-up, and further endocrinological evaluation was performed in 86 participants.

Results

Six women (4.6%, n = 131) were diagnosed with hypopituitarism, four (3.1%) with central hypothyroidism and two with growth hormone deficiency (1.5%). Ten women (7.6%) had hyperprolactinemia, and four (3.1%) of them had prolactinoma. Medical treatment was initiated in 13 (9.9%) women. Significant prognostic factors were not found.

Conclusions

As 12.2% of female athletes with a history of mild traumatic brain injury had pituitary dysfunction (hypopituitarism 4.6%, hyperprolactinemia 7.6%), we conclude that pituitary dysfunction is an important consideration in post-concussion care. Hyperprolactinemia in the absence of prolactinoma may represent pituitary or hypothalamic injury following mild traumatic brain injury.

Significance statement

Mild traumatic brain injury (mTBI) has become a growing public health concern as 50 million people worldwide sustain a traumatic brain injury annually, with mTBI being the most common (70–90%). As studies on mTBI have focused on mostly male populations this study aims to explore pituitary dysfunction (PD) in female athletes following mTBI. To the best of our knowledge, it is the first all-female study on PD following mTBI.

The study found that 12.2% of the participating women had PD after mTBI. Six (4.6%) had hypopituitarism and ten (7.6%) had hyperprolactinemia. These findings suggest that PD following mTBI is an important consideration that endocrinologists and other medical staff working with athletes need to be aware of.

客观的

轻度创伤性脑损伤后的垂体功能障碍可能会产生严重的身体和心理后果，因此正确的诊断和治疗至关重要。据我们所知，这项研究是第一个研究全女性人群轻度创伤性脑损伤后垂体功能障碍的患病率的研究，在筛查女运动员垂体功能障碍后进行了详细的内分泌检查。

设计

这是一项回顾性队列研究。

方法

对 133 名女运动员进行了激素筛查血液检查，包括促甲状腺激素、游离甲状腺素、胰岛素样生长因子 1、催乳素、皮质醇、卵泡刺激素、黄体生成素、雌激素和黄体酮的血清值。88 名女性的结果多次超出参考值，需要进一步的内分泌学评估。其中两人失访，并对 86 名参与者进行了进一步的内分泌评估。

结果

六名女性（4.6%，n  = 131）被诊断患有垂体功能减退症，四名女性（3.1%）患有中枢性甲状腺功能减退症，两名女性患有生长激素缺乏症（1.5%）。10 名女性（7.6%）患有高泌乳素血症，其中 4 名（3.1%）患有泌乳素瘤。13 名 (9.9%) 女性开始接受治疗。未发现显着的预后因素。

结论

由于有轻度创伤性脑损伤病史的女运动员中有 12.2% 患有垂体功能障碍（垂体功能减退症 4.6%，高催乳素血症 7.6%），因此我们得出结论，垂体功能障碍是脑震荡后护理中的一个重要考虑因素。没有泌乳素瘤的高泌乳素血症可能代表轻度创伤性脑损伤后的垂体或下丘脑损伤。

意义陈述

轻度创伤性脑损伤 (mTBI) 已成为日益严重的公共卫生问题，全球每年有 5000 万人遭受创伤性脑损伤，其中 mTBI 是最常见的 (70-90%)。由于 mTBI 的研究主要集中在男性人群，本研究旨在探讨 mTBI 后女性运动员的垂体功能障碍 (PD)。据我们所知，这是第一个针对 mTBI 后 PD 的全女性研究。

研究发现，12.2% 的参与女性在 mTBI 后患有 PD。六名 (4.6%) 患有垂体功能减退症，十名 (7.6%) 患有高催乳素血症。这些研究结果表明，mTBI 后的 PD 是内分泌学家和其他与运动员一起工作的医务人员需要注意的一个重要考虑因素。