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Citation
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Klose M, Stochholm K, Janukonyté J, Lehman Christensen L, Frystyk J, Andersen M, Laurberg P, Sandahl Christiansen J, Feldt-Rasmussen U. J. Clin. Endocrinol. Metab. 2014; 99(1): 101-110. |
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Abstract
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Context: Recent international guidelines suggest pituitary screening in patients with moderate and severe traumatic brain injury (TBI). Predominantly isolated GH deficiency (GHD) was reported in the literature raising the question of potential methodological bias.ObjectiveTo assess the prevalence of GHD in patients admitted in 2008 with TBI, with concurrent assessment of methodological bias.
Design: Nationwide population based cohort study.
Setting: Tertiary referral University HospitalsParticipantsDanish patients with a head trauma diagnosis from Danish Board of Health diagnostic code registry; 439 patients and 124 healthy controls underwent dynamic assessment of GH secretion median 2.5 years after TBI.
Main outcome: Prevalence of GHD given use of 1) local versus guideline cut-offs, 2) insulin tolerance test (ITT), pyridostigmin-GHRH (PD-GHRH) or GHRH-arginine (GHRH-arg) test, 3) single versus repeated testing, and 4) GH-assessment by assays with different isoform specificity.
Results: The prevalence of GHD was lower by local than guideline cut-offs (12% vs. 19% (PD-GHRH/GHRH-arg, P<0.001); 4.5% vs. 5% (ITT, P=0.9)), and by ITT than PD-GHRH/GHRH-arg (P=0.006 (local cut-offs); P<0.001 (guideline cut-offs)). Only 1% of patients had GHD upon two tests. GH assessment by the Immulite or iSYS-assay caused no significant diagnostic differences.
Conclusions: The study confirmed a high risk of bias in the management of pituitary testing of patients with TBI, and stresses the importance of a proper control group and stringent GH-testing including confirmatory testing, in cohorts with low a-priori likelihood of GHD such as in TBI. Our results question the evidence for newly introduced recommendations for routine pituitary assessment in TBI.
Language: en |