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Mild traumatic brain injury in female athletes - possible pituitary dysfunction and effect on psychological and neuropsychological function

Year: 2024
Type: dissertation
Study design: Observational Study
Abstract: Hypopituitarism (HP) can occur following mild traumatic brain injury (mTBI) with an estimated a prevalence of 13 – 48%. As HP can be treated with hormonal replacement therapy and symptoms of HP may overlap with symptoms of mTBI, HP represents a potentially treatable cause of mTBI symptoms. Women remain an understudied population with regards to HP following mTBI even though the incidence of mTBI appears to be greater and recovery time longer in women compared to men. Thus, studies on the effects of mTBI in female samples are highly needed. The aim of this thesis was to identify female athletes needing further endocrinological evaluation for possible pituitary dysfunction (PD), including both HP and hyperprolactinemia (HPRL), following mTBI, find the prevalence of PD following mTBI in female athletes, identify possible predictive factors for PD after mTBI, including psychological and neuropsychological predictive factors, and evaluate psychological and neuropsychological outcome as well as quality of life in women with PD following mTBI compared to women with normal pituitary function (nPF). To the best of our knowledge, this study is the first to report the prevalence of PD after mTBI and the effect of PD on psychological and neuropsychological function in an all-female population. Female athletes (n = 508) in Iceland participated by answering online questionnaires regarding mTBI history and mental health. One or more mTBI was reported by 308 women and 166 (53.8%) of them accepted further participation which included neuropsychological tests. Of these 166 women, 151 (90.9%) participated in a medical interview. Following the medical interview, screening blood tests (SBT) for each pituitary axis were performed in 133 (88.1%) at 8 A.M. When SBT were repeatedly outside the reference value (O-RV), a detailed endocrinological evaluation was performed including further endocrinological testing when indicated. Repeated hormonal SBT were O-RV in 88 women (66.2%, n = 133). Lower age and increased number of mTBI symptoms were associated with increased risk of SBT O-RV. Following a detailed endocrinological evaluation, 16 (12.2%, n = 131) women were diagnosed with PD after mTBI, six (4.6%) with HP (central hypothyroidism n = 4, 3.1% and growth hormone deficiency n = 2, 1.5%) and ten (7.6%) with HPRL. Of the ten women who had HPRL, four (3.0%, n = 131) had a prolactinoma and six (4.6%, n =131) did not. Medical treatment was required in 13 women (9.9%, n = 131). Significant prognostic factors for PD following mTBI were not found. Women with PD had a significantly higher mean Sustained Attention to Response Task error score (SARTes) than women with nPF (16.7 and 12.8 respectively; p = 0.04). There were no other significant differences between women with PD and women with nPF with regards to psychological symptoms, neuropsychological symptoms or quality of life. Following pituitary hormone SBT, further endocrinological evaluation was indicated in a large majority (66.2%, n = 133) of the population. Lower age and increased number of symptoms of mTBI indicates that screening for HP following mTBI is required. Following further endocrinological evaluation a substantial proportion of female athletes (12.2%) were diagnosed with PD after mTBI. Women with PD following mTBI had a higher mean SARTes indicating decreased sustained attention or inhibitory performance. As 12.2% of the female athletes were diagnosed with PD, it is an important concern after mTBI. Thus, endocrinological evaluation for possible PD following mTBI is indicated in women of a younger age, if prominent symptoms of mTBI are present, or in women who have higher SARTes and a history of mTBI.
Author: Eggertsdóttir Claessen, Lára Ósk
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W7011574331
Cites: 295
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Related to: 10