The DOI matches its Crossref record; 57 of the 59 references it cites were found in a registry or an index; 1 of the 24 sources its claims cite were checked for support.
Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury
Abstract
Recent data suggest that anterior pituitary dysfunction after traumatic brain injury (TBI) is common. We sought to confirm the results of earlier studies in a larger cohort of patients with dynamic testing of pituitary function. We studied 102 consecutive TBI survivors (85 males; median age 28, range 15-65 yr) who had survived severe or moderate TBI (initial Glasgow Coma Scale score 3-13) at a median of 17 months (range 6-36) post event. GH and ACTH reserves were initially assessed using the glucagon stimulation test (GST). Normative data on GH and cortisol responses to the GST were obtained from 31 matched healthy controls. Patients with subnormal GH or cortisol responses were further evaluated, using the insulin tolerance test (ITT) or arginine + GHRH test for GH assessment and the ITT or 250-microg short synacthen test for the assessment of ACTH reserve. Patients were considered to be GH or ACTH deficient if they failed both the GST and the second provocative test. Baseline thyroid function, prolactin, IGF-I, gonadotropins, testosterone, or estradiol was performed in all patients and compared with local reference ranges.In controls, normal response to the GST was a stimulated GH peak of greater than 5 microg/liter and cortisol peak greater than 450 nmol/liter (16 microg/dl). Eighteen TBI patients (17.6%) had GH response to the GST less than 5 microg/liter, 11 of whom also failed the ITT or the arginine + GHRH tests. GH-deficient patients had significantly higher body mass index (P = 0.003), and lower IGF-I concentrations (P < 0.001), than GH-sufficient patients. Twenty-three patients (22.5%) had cortisol responses to GST less than 450 nmol/liter, 13 of whom also failed the ITT or short synacthen test. GH or ACTH deficiencies were not related to age, Glasgow Coma Scale score, or the presence of other pituitary hormone abnormalities (P > 0.05). Twelve patients (11.8%) had gonadotropin and one (1%) had thyrotrophin deficiencies. Twelve patients (11.8%) had hyperprolactinemia. Twenty-nine patients (28.4%) had at least one anterior pituitary hormone deficiency. This is the largest study, to date, of hypopituitarism after TBI and confirms a high prevalence of undiagnosed anterior pituitary hormone abnormalities in survivors of TBI. Hypopituitarism is a treatable cause of morbidity after TBI. In addition to conventional pituitary hormone replacement, the potential of GH treatment to enhance recovery needs to be examined in a prospective study.
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27 Own result · 11 No full text of the sources · 10 Own interpretation · 5 Own method · 3 Sources not found · 3 No basis given · 2 Not checked yet · 1 Couldn’t confirm · accuracy not yet measured
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In the paper
“However, it is not possible to be certain that the five patients who failed the GST but passed the SST have intact corticotrophic function because of well-reported falsepass results with the latter test (45)(46)(47)(48).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [45] 45. Mukherjee JJ, de Castro JJ, Kaltsas G, Afshar F, Grossman AB, Wass JA, Besser GM 1997 A comparison of the insulin tolerance/glucagon test with the short ACTH test in the assessment of the hypothalamo-pituitary-adrenal axis in the early post-operative period after hypophysectomy. Clin Endocrinol (Oxf) 47:51-60 source
- Not matchedcites [46] 46. Thaler LM, Blevins LS 1998 The low dose (1-g) adrenocorticotropin stim- ulation test in the evaluation of patients with suspected central adrenal in- sufficiency. J Clin Endocrinol Metab 83:2726 -2729
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Could not verifycites [47] 47. Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR 2001 Longitu- dinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 86:724 -731 sourceExperimental — accuracy not yet measured
The Assays and Discussion passages (page numbers unavailable) concern testosterone measurement and hypogonadism in aging men, not GST, SST, or corticotrophic function. Searches for SST false-pass results and glucagon stimulation versus short Synacthen testing found no passage addressing the claim. (LLM, conf=0.78)
plainn = 5- Asserted: passes — The authors put it forward as true.
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In the paper
“Twelve patients (11.8%, 10 males) had gonadotropin deficiency, which was associated with hyperprolactinemia in four patients (three males).”
- Also stated in: § Abstract · plain
“Twelve patients (11.8%) had gonadotropin and one (1%) had thyrotrophin deficiencies.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Other hormone abnormalities
plainn = 12- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Abstract · plain
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In the paper
“Diagnosing ACTH deficiency by failure of two provocative tests, 13 patients (12.7%) were defined as ACTH deficient.”
- Also stated in: § Abstract · plain
“13 of whom also failed the ITT or short synacthen test.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > The corticotrophic-adrenal axis
plainn = 13- Asserted: passes — The authors put it forward as true.
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In the paper
“TSH deficiency was present in one patient, who had panhypopituitarism (Fig. 2).”
- Also stated in: § Abstract · plain
“one (1%) had thyrotrophin deficiencies.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Other hormone abnormalities
plainSingle case- Asserted: passes — The authors put it forward as true.
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In the paper
“Hyperprolactinemia was present in 12 patients (one patient was on risperidone).”
- Also stated in: § Abstract · plain
“Twelve patients (11.8%) had hyperprolactinemia.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Other hormone abnormalities
plainn = 12- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Defining GH deficiency as failing two different stimulation tests, 11 patients (10.7%) had GH deficiency including eight (7.8%) with severe deficiency.”
- Also stated in: § Abstract · plain
“11 of whom also failed the ITT or the arginine ؉ GHRH tests.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > GH-IGF-I axis
plainn = 11- Asserted: passes — The authors put it forward as true.
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In the paper
“Four of the 12 patients with gonadotropin deficiency had hyperprolactinemia, which may have been responsible for this abnormality.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plainconditionaln = 12- Asserted: passes — The authors put it forward as true.
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In the paper
“There was no difference in the AGHDA scores between GH-deficient and -sufficient subjects”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
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“Our data show that in a large, unselected population of survivors of moderate or severe TBI who are studied well after the initial trauma, there is a significant prevalence of undiagnosed hypopituitarism.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
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“GH-deficient patients had lower serum IGF-I concentrations than GH-sufficient patients (P Ͻ 0.001).”
- Also stated in: § Abstract · plain
“lower IGF-I concentrations (P < 0.001), than GH-sufficient patients.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > GH-IGF-I axis
plaincorrelationaln = 11 ·- Asserted: passes — The authors put it forward as true.
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- The quote only partly states this claim. 1
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In the paper
“Twenty-nine patients (28.4%) had at least one anterior pituitary hormone deficiency.”
- Also stated in: § Overall results · plain
“Twenty-nine patients (28.4%) had at least one anterior pituitary hormone deficiency.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Abstract
plainn = 29- Asserted: passes — The authors put it forward as true.
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In the paper
“Twenty-three patients (22.5%) had isolated hormone deficiencies and six (5.9%) has mul- tiple hormone deficiencies.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Overall results
plainn = 23- Asserted: passes — The authors put it forward as true.
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“Multifactorial logistic regression analysis showed that hyperprolactinemia was not associated with age, GCS score, cerebral edema, or operative mass evacuation (P Ͼ 0.05 for each variable).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Other hormone abnormalities
plainn = 12- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
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In the paper
“The TBI patients in this study who had subnormal GH responses to the GST did show biochemical and somatic features of GHD, in that they also had lower serum IGF-I levels and higher BMI than those with normal GH responses.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Fifty-seven patients (55.9%) had recovered well after TBI (GOS score ϭ 5), 33 patients (32.3%) had moderate disability (GOS score ϭ 4), and 12 patients (11.8%) had severe disability (GOS score ϭ 3).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Results
plainn = 57- Asserted: passes — The authors put it forward as true.
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In the paper
“but was unrelated to hyperprolactinemia (P ϭ 0.786), gender (P ϭ 0.375), BMI (P ϭ 0.728), GCS scores (P ϭ 0.561), CT scan appearance (P ϭ 0.064), cerebral edema (P ϭ 0.896), or mass evacuation (P ϭ 0.357).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Other hormone abnormalities
plainn = 12- Asserted: passes — The authors put it forward as true.
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In the paper
“Seven of the 18 patients who failed the GST passed either the ITT or arginine ϩ GHRH, showing some discordance between these provocative tests of GH secretion.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plainn = 18- Asserted: passes — The authors put it forward as true.
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In the paper
“GH deficiency to be associated with higher BMI (P ϭ 0.009) but unrelated to age (P ϭ 0.524), gender (P ϭ 0.225), GCS scores (P ϭ 0.314), CT scan appearance (P ϭ 0.589), cerebral edema (P ϭ 0.710), operative mass evacuation (P ϭ 0.579), the presence of gonadotropin (P ϭ 0.494) or ACTH (P ϭ 0.422) deficiencies, or hyperprolactinemia (P ϭ 0.752).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > GH-IGF-I axis
plainn = 11- Asserted: passes — The authors put it forward as true.
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In the paper
“ACTH deficiency was not significantly related to age (P ϭ 0.916), gender (P ϭ 0.952), BMI (P ϭ 0.170), GCS score (P ϭ 0.798), CT scan appearance (P ϭ 0.670), cerebral edema (P ϭ 0.543), operative mass evacuation (P ϭ 0.558), or gonadotropin deficiency (P ϭ 0.129); the association with hyperprolactinemia was of borderline nonsignificance (P ϭ 0.058).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > The corticotrophic-adrenal axis
plain- Asserted: passes — The authors put it forward as true.
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“Completed studies were performed in all patients.No serious adverse reactions to any of the tests were observed.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Results
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Because the thyrotrophs are located more medially within the adenohypophysis in the protected territory of the short hypophyseal vessels (7, 52), they may be less susceptible to traumatic injury than the rest of the anterior lobe, which receives its blood supply predominantly from the more vulnerable long hypophyseal vessels (7).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [7] 7. Kelly DF, Gonzalo ITW, Cohan P, Berman N, Swerdloff R, Wang C 2000 Hypopituitarism following traumatic brain injury and aneurysmal subarach- noid hemorrhage: a preliminary report. J Neurosurg 93:743-752 source
- Not checked — no full text of the sourcecites [52] 52. Cuneo RC, Salomon F, Wiles CM, Hesp R, Sonksen PH 1991 Growth hor- mone treatment in growth hormone deficient adults II: effect on exercise performance. J Appl Physiol 70:695-700 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“our data are broadly in agreement with earlier, smaller studies.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“GH deficiency is associated with reduced lean body mass (53), decreased exercise capacity (54), impaired cardiac function (55), and reduction in bone mineral density (56), which may be of particular significance in immobilized patients, as well as sleep disturbances, social isolation, reduced physical mobility, and general well-being (57).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [53] 53. Merola B, Cittadini A, Colao A, Longobardi S, Fazio S, Sabatini D, Sacca L, Lombardi G 1993 Cardiac structure and functional abnormalities in adult patients with growth hormone deficiency. J Clin Endocrinol Metab 77:1658 - 1661 source
- Not matchedcites [54] 54. Colao A, Di Somma C, Pivonello R, Loche S, Aimaretti G, Cerbone G, Faggiano A, Corneli G, Ghigo E, Lombardi G 1999 Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopitu- itarism. J Clin Endocrinol Metab 84:1919 -1924
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [55] 55. Bjork S, Jonsson B, Westphal O, Levin J-E 1989 Quality of life of adults with growth hormone deficiency: a controlled study. Acta Paediatr Scand 356(Suppl):55-59 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“All these effects can have the potential to impair recovery and rehabilitation and may contribute to the significant morbidity associated with TBI.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Rests on an assumption: Testosterone deficiency in males leads to reduced lean body mass and reduced bone mineral density; estrogen deficiency in females predisposes them to premature osteoporosis.
- Rests on an assumption: Deficiency in thyroid hormones leads to anergia, muscle weakness, and neuropsychiatric disorders.
- Rests on an assumption: Glucocorticoid deficiency can be life threatening, particularly in acutely ill patients, and may impair recovery and rehabilitation in the post-TBI period due to lethargy, muscle fatigue, and poor exercise capacity.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four of the 12 patients with gonadotropin deficiency had hyperprolactinemia, which may have been responsible for this abnormality.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
hedgedconditionaln = 4- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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In the paper
“We would defend our data on the basis of the larger size of our cohort, the use of two separate dynamic tests of glucocorticoid secretion, and our rigorous definition for ACTH deficiency.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Pituitary insufficiency may have serious consequences and may aggravate the physical and neuropsychiatric morbidity observed after head injury.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Rests on an assumption: Testosterone deficiency in males leads to reduced lean body mass and reduced bone mineral density; estrogen deficiency in females predisposes them to premature osteoporosis.
- Rests on an assumption: Deficiency in thyroid hormones leads to anergia, muscle weakness, and neuropsychiatric disorders.
- Rests on an assumption: Glucocorticoid deficiency can be life threatening, particularly in acutely ill patients, and may impair recovery and rehabilitation in the post-TBI period due to lethargy, muscle fatigue, and poor exercise capacity.
In the paper
“Our results also contrast with those of Kelly et al. (7), who found only one patient with blunted cortisol response to hypoglycemia, although in this last study, the 95% confidence limit for the area under the curve for cortisol responses was used to define normality, rather than the more conventional peak cortisol response.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [7] 7. Kelly DF, Gonzalo ITW, Cohan P, Berman N, Swerdloff R, Wang C 2000 Hypopituitarism following traumatic brain injury and aneurysmal subarach- noid hemorrhage: a preliminary report. J Neurosurg 93:743-752 source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“It is well recognized that serum testosterone levels decline with age (49).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [49] 49. Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML 1989 Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 70:145-160 source
boosteddirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“We did not use the GnRH test for the assessment of gonadotrophic function because this test lacks both sensitivity and specificity and rarely adds any helpful additional information (35,36).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [35] 35. Rahim A, Toogood A, Shalet SM 1996 The assessment of growth hormone status in normal young adult males using a variety of provocative agents. Clin Endocrinol (Oxf) 45:557-562 source
- Not checked — no full text of the sourcecites [36] 36. Pfeifer M, Kanc K, Verhovec R, Kocijancic A 2001 Reproducibility of the insulin tolerance test (ITT) for assessment of growth hormone and cortisol secretion in normal and hypopituitary adult men. Clin Endocrinol (Oxf) 54: 17-22 source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The frequency of TSH deficiency with relation to other anterior pituitary hormone abnormalities, in pituitary disorders, is variable (50,51).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not matchedcites [50] 50. Asa S, Kovacs K, Melmed S 2002 Functional anatomy of the hypothalamic pituitary axis. In: Melmed S, ed. The pituitary. 2nd ed. Cambridge, UK: Black- well Science; 4 -44
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [51] 51. Binnerts A, Deurenberg P, Swart GR, Wilson JHP, Lamberts SWJ 1992 Body composition in growth hormone deficient adults. Am J Clin Nutr 55:918 -923 source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because hypopituitarism may impair recovery from TBI and because the benefit of replacement of hormone deficiencies is well established, identification of post-TBI hypopituitarism offers the potential to improve the chances of rehabilitation and enhance QoL.”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
- Rests on an assumption: The benefit of replacement of hormone deficiencies is well established.
In the paper
“Our results are more comparable with those of Lieberman et al. (8)”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not matchedcites Lieberman et al. (8) 8. Lieberman SA, Oberoi AL, Gilkinson CR, Masel BE, Urban RJ 2001 Prev- alence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 86:2752-2756
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
In the paper
“It is important to acknowledge that most patients with pituitary disease who pass the standard 250-g SST do well without glucocorticoid replacement (29).”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
What the sources say
- Not checked — no full text of the sourcecites [29] 29. Trainer PJ, Besser GM 1995 Barts endocrine protocols. Edinburgh: Churchill Livingstone International; 6 -8
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper relies on this without support.
Anterior pituitary dysfunction after traumatic brain injury is common.
“Recent data suggest that anterior pituitary dysfunction after traumatic brain injury (TBI) is common.”
The paper relies on this without support.
Normal GH and cortisol responses to the glucagon stimulation test are not well established.
“Because normal GH and cortisol responses to the GST are not well established, we performed the GST in 31 healthy subjects (22 males) who were matched for age, sex, and body mass index (BMI) to the patient population.”
The paper relies on this without support.
This is the largest study to date of hypopituitarism after TBI.
“This is the largest study, to date, of hypopituitarism after TBI and confirms a high prevalence of undiagnosed anterior pituitary hormone abnormalities in survivors of TBI.”
The paper relies on this without support.
Hypopituitarism is a treatable cause of morbidity after TBI.
“Hypopituitarism is a treatable cause of morbidity after TBI.”
The paper relies on this without support.
Under stressed conditions, such as intercurrent illness, mild untreated ACTH deficiency may become life threatening.
“However, under stressed conditions, such as intercurrent illness, mild untreated ACTH deficiency may become life threatening.”
The paper relies on this without support.
No study in adults has compared the glucagon stimulation test with the arginine + GHRH test.
“No study, in adults, has compared the GST with the arginine ϩ GHRH test.”
The authors state this as an assumption.
The three patients without documented GCS scores were assumed to have a GCS of 13 or less because they were admitted to the intensive care unit.
“The three remaining patients had no documented GCS scores but were admitted to the intensive care unit (ITU) and therefore were assumed to have a GCS of 13 or less.”
The paper relies on this without support.
The GST has well-recognized false-fail results.
“The discordance between the GST and ITT results in five of the 15 patients who failed the GST can be explained by the well-recognized false-fail results associated with the GST.”
The paper relies on this without support.
Testosterone deficiency in males leads to reduced lean body mass and reduced bone mineral density; estrogen deficiency in females predisposes them to premature osteoporosis.
“Testosterone deficiency in males leads to reduced lean body mass and reduced bone mineral density; estrogen deficiency in females predisposes them to premature osteoporosis.”
The paper relies on this without support.
Deficiency in thyroid hormones leads to anergia, muscle weakness, and neuropsychiatric disorders.
“Deficiency in thyroid hormones leads to anergia, muscle weakness, and neuropsychiatric disorders.”
The paper relies on this without support.
The benefit of replacement of hormone deficiencies is well established.
“Because hypopituitarism may impair recovery from TBI and because the benefit of replacement of hormone deficiencies is well established, identification of post-TBI hypopituitarism offers the potential to improve the chances of rehabilitation and enhance QoL.”
The paper relies on this without support.
The study's patient sample was representative of survivors of TBI admitted to the study unit.
“Although our patient sample was representative of survivors of TBI admitted to our unit, only a small number of our patients had long-term severe disability.”
The paper relies on this without support.
Glucocorticoid deficiency can be life threatening, particularly in acutely ill patients, and may impair recovery and rehabilitation in the post-TBI period due to lethargy, muscle fatigue, and poor exercise capacity.
“Glucocorticoid deficiency can be life threatening, particularly in acutely ill patients, and may impair recovery and rehabilitation in the post-TBI period due to lethargy, muscle fatigue, and poor exercise capacity.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“new corticotroph, thyrotroph and posterior pituitary deficiencies (permanent diabetes insipidus) are less common with rates averaging 8%, 5% and 2%, respectively”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies.”
From Pituitary dysfunction following traumatic brain injury: clinical perspectives (2015) · cites this paper as [8]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The somatotrophs and gonadotrophs, which are located in the area of the pituitary perfused by long hypophyseal portal vessels, are the most frequent hormonal deficiencies after TBI (15, 18, 27, 29, 150, 160); however, in some studies ACTH deficiency (corticotrophs are located in the territory supplied by the short portal vessels) is the most common or second most common hormonal deficiency after”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [29]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Some of these early abnormalities are transient and recover fully within days or weeks after TBI while new pituitary hormone deficiency may become apparent in the post-acute phase (13, 14).”
From Post-Traumatic Hypopituitarism—Who Should Be Screened, When, and How? (2018) · cites this paper as [14]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The most robust data with regard to incidence of PTHP are in those patients with moderate or severe TBI (14).”
From Post-Traumatic Hypopituitarism—Who Should Be Screened, When, and How? (2018) · cites this paper as [14]
Experimental — accuracy not yet measured
The cited source says what the claim attributes to it.
In the citing paper
“however, in three studies, confirmatory testing was applied if a screening test was positive (29,30,255; Table 2).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [29]
The cited source says what the claim attributes to it.
In the citing paper
“Additionally, most studies did not include a control group.Only three studies included matched control groups (27,29,30; Table 2).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [29]
The cited source says what the claim attributes to it.
In the citing paper
“In the TBI population, this test has been used by some authors (18,29,196,197) without adverse effects, but other authors have used alternative tests, suggesting the possible danger of ITT (195,198).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [29]
The cited source says what the claim attributes to it.
In the citing paper
“In most studies, no significant associations between TBI severity according to postresuscitation GCS and hypopituitarism in the chronic phase have been reported (15, 23, 24, 27, 29, 181, 231-233), whereas others have demonstrated that hypopituitarism was more frequent in patients with more severe TBI (18,30,154).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [29]
The cited source says what the claim attributes to it.
In the citing paper
“The data on this is limited with one study demonstrating a correlation between diffuse brain swelling and PTHP (19) and another finding no such association (14).”
From Post-Traumatic Hypopituitarism—Who Should Be Screened, When, and How? (2018) · cites this paper as [14]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“new corticotroph, thyrotroph and posterior pituitary deficiencies (permanent diabetes insipidus) are less common with rates averaging 8%, 5% and 2%, respectively”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
Experimental — accuracy not yet measuredIn the citing paper
“Chronic anterior hypopituitarism, although reversible in some patients, persists in 25–40% of moderate and severe TBI survivors”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“Collectively, these studies indicate that by 6–12 months post-injury, 25–40% of moderate and severe TBI patients will develop chronic hypopituitarism”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“with the somatotroph and gonadotroph axes being most commonly affected [5, 30–43]”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“New chronic somatotroph failure (growth hormone deficiency) averages 15–18% of patients”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“followed by hypogonadism with rates averaging 14%”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“new corticotroph, thyrotroph and posterior pituitary deficiencies (permanent diabetes insipidus) are less common with rates averaging 8%, 5% and 2%, respectively”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
In the citing paper
“Most prior studies have failed to show a definitive relationship between injury-related factors and the development of hypopituitarism [32, 39–41, 44, 45, 70–72].”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [32]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > GH-IGF-I axis
“Eighteen patients (17.6%) had a GH response to glucagon less than 5 g/liter, including 13 (12.7%)with a response less than 3 g/liter”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
“| 12/M | 23.7 | 26 | 3.16 | 5.4 | Ϫ0.87 | | | 13/M | 34.3 | 50 | 3.96 | 10.7 | Ϫ0.74 | ACTH | | 14/M | 33.5 | 51 | 3.18 | 10.4 | 1.11 | ACTH | | 15/M | 21.9 | 45 | 2.98 | 6.3 | 0.77 | | | 16/M | 33.9 | 20 | 3 | 5.8 | Ϫ0.57 | | | 17/M | 22.3 | 22 | 4.15 | 25.5 | 0.53 | | | 18/F | 33.3 | 60 | 3.24 | 24.5 | 1.5 | GT |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
“| BMI (kg/m 2 ) a | 28.13 Ϯ 4.8 | 24 Ϯ 3.8 | 0.003 |”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
“| BMI (kg/m 2 ) a | 24.2 Ϯ 4 | 25.9 Ϯ 4.9 | 0.238 |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
“Four of the 12 patients with gonadotropin deficiency had hyperprolactinemia”
§ Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury > Discussion
“| Hyperprolactinemia (n) | 3 | 9 | 0.148 |”
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Traumatic Brain Injury: A Disease Process, Not an Event
Masel, B. E., & DeWitt, D. S. (2010) · Journal of Neurotrauma · doi:10.1089/neu.2010.1358 · Cited by 998
“TBI is associated with a host of neuroendocrine disorders, due perhaps to the induction of complex hormonal responses in the hypothalamicpituitary-end-organ axes that ultimately lead to acute and/or chronic post-traumatic hypopituitarism (PTH).”
BackgroundInfluentialSchneider, H. J., Kreitschmann-Andermahr, I., Ghigo, E., Stalla, G. K., & Agha, A. (2007) · JAMA · doi:10.1001/jama.298.12.1429 · Cited by 549
“Gonadotrophic hormone deficiency is often transient in the early period after brain injury.(14,15,21,22) To date, there is no clear evidence for replacement of sex steroids in the acute phase of TBI or SAH.”
BackgroundMethodSelf-citationMolitch, M. E., Clemmons, D. R., Malozowski, S., Merriam, G. R., Shalet, S. M., & Vance, M. L. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-2227 · Cited by 422
Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study
Aimaretti, G., Ambrosio, M. R., Di Somma, C., Gasperi, M., Cannavò, S., Scaroni, C., Fusco, A., Del Monte, P., De Menis, E., Faustini-Fustini, M., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0504 · Cited by 370
“This picture is impressive and fits well with observation made by others (5, 6, 15).”
BackgroundResultInfluential
Metadata
- Authors
- Agha, A., Rogers, B., Sherlock, M., O’Kelly, P., Tormey, W., Phillips, J., & Thompson, C. J.
- Affiliations
- Beaumont Hospital (IE)
- Corresponding author
- Thompson, Christopher J.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2004-10
- Volume
- 89
- Issue
- 10
- Pages
- 4929-4936
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2077490225
- Semantic Scholar
- b57d05b038775cd07617187bad96eced97cfcfce
- Cited by
- 390
- References
- 59
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 14 · 2023: 6 · 2022: 7 · 2021: 11 · 2020: 15 · 2019: 17 · 2018: 16 · 2017: 15 · 2016: 17 · 2015: 28 · 2014: 15 · 2013: 20 · 2012: 23
- FWCI
- 17.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Pfizer
- Royal College of Surgeons in Ireland
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- traumatic brain injury, anterior pituitary dysfunction, growth hormone deficiency, ACTH deficiency, glucagon stimulation test, insulin tolerance test, ACTH stimulation test, insulin-like growth factor I, body mass index, hyperprolactinemia, gonadotropin deficiency, thyrotropin deficiency, pituitary hormone replacement
- MeSH terms
- Adolescent, Adrenocorticotropic Hormone, Adult, Aged, Brain Injuries, Disability Evaluation, Female, Gonadotropins, Humans, Hydrocortisone, Hypopituitarism, Male, Middle Aged, Pituitary Diseases, Thyrotropin, Cohort Studies, Prevalence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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