THU091 Hypopituitarism And The Finding Of Hyperprolactinemia Following Mild Traumatic Brain Injury In Female Athletes
Authors: Claessen Lára Ósk Eggertsdóttir , Kristjánsdóttir Hafrún , Jónsdóttir María K , Lund Sigrún H , Kristensen Ingunn S U , Sigurjónsdóttir Helga Á 
Published: October 2023

Abstract
Disclosure: L.Ó. Eggertsdóttir Claessen: None. H. Kristjánsdóttir: None. M.K. Jónsdóttir: None. S.H. Lund: Employee; Self; Amgen Inc. I.S. Kristensen: None. H.Á. Sigurjónsdóttir: None.
Background Hypopituitarism (HP) following mild traumatic brain injury (mTBI) in sports can have serious consequences making prompt diagnosis and treatment essential. Studies have focused on male populations despite female athletes being more susceptible to mTBI. To the best of our knowledge, this study is the first all-female study reporting the prevalence of HP following mTBI. Subjects The study included 508 female athletes aged 18 to 45 years currently active in or retired from soccer, team handball, basketball, ice hockey, and martial arts who answered an online questionnaire regarding mTBI history. Women who reported one or more concussions (n = 308) were invited to participate in a medical interview and a physical examination with 151 accepting. Consequently, 133 women attended pituitary hormone screening blood tests (SBT). Methods SBT were taken at 8 a.m. and included S-IGF1, S-cortisol, S-prolactin, S-TSH, S-fT4, S-FSH, S-oestrogen, and S-progesterone measurements. When SBT were repeatedly outside reference value (O-RV), participants were referred to an endocrinologist for a medical interview and physical examination. Detailed endocrinological tests for possible HP were performed as indicated. When serum levels of TSH or fT4 were O-RV, anti-TPO antibodies were measured and when negative, an MRI was performed. If S-prolactin was repeatedly above reference value (RV) an MRI was performed. When S-cortisol was below 350 mmol/L, morning plasma ACTH was added and morning Synacthen test performed. When S-IGF1 was below median RV and clinical symptoms of GHD were present, a GHRH-arginine test was performed. An ITT was performed in one woman due to practical reasons and strong clinical symptoms indicating GHD. Results etailed endocrinological evaluation for possible HP was indicated in 86 women. Pituitary dysfunction (PD) was diagnosed in 16 women (12.0%). Six (4.5%) women had HP. One woman had GH measurements below RV in a GHRH-arginine test (peak GH levels ≤11.0 µg/L for BMI &lt;25 kg/m2) and one had GH below &lt;3µg/L in an ITT. Four women had low or normal TSH levels (reference range 0.270 - 4.20 mIU/L), low fT4 (reference range 12 - 22 pmol/L) and a negative anti-TPO measurement. Ten women (7.5%) had hyperprolactinemia (HPRL) (reference range 4.79 - 23.3 μg/L). Four of the 10 women with HPRL were diagnosed with a prolactinoma following an MRI. Medical treatment was initiated for 13 (9.8%) women as one woman had a prolactinoma but no clinical symptoms of HPRL. Conclusions PD is an important consideration in post-concussion care as 12.0% had PD following mTBI with 9.8% requiring medical treatment. Six women (4.5%) had HP following mTBI (GHD = 2 and central hypothyroidism n = 4). This is lower than previously reported and may be due to HP recovering with time. As six women had HPRL without a prolactinoma, HRPL may represent pituitary or hypothalamic injury following mTBI.
Presentation: Thursday, June 15, 2023