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Risk Factors for Anterior Hypopituitarism in Patients With Traumatic Brain Injury

You, Wendong MD*; Zhu, Yuanrun MD*; Wen, Liang MD*; Sun, Yun MD; Pan, Desheng PhD*; Yang, Xiaofeng MD*

doi: 10.1097/SCS.0000000000005405
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Background: Hypopituitarism is a common but potentially undiagnosed complication in patients who suffer traumatic brain injury (TBI). The identification of risk factors of hypopituitarism after TBI is vital to establish a rational testing approach for these patients.

Methods: The authors retrospectively reviewed the case records of patients with TBI, who underwent pituitary function evaluation in our department between January 2014 and December 2016.

Results: In all, 193 patients (66.3% male) hospitalized with TBI were included in this study. Anterior hypopituitarism was observed in 33 (17.1%) patients, with 4.7% of the patients having multiple pituitary axes dysfunction. Patients with hypopituitarism had a longer length of ICU stay (8.7 ± 5.5 versus 3.3 ± 4.6, P < 0.001), longer length of total hospital stay (28.7 ± 20.1 versus 21.0 ± 15.8, P = 0.011), and lower Glasgow coma scale (GCS) on admission (9.1 ± 3.5 versus 11.8 ± 3.6, P < 0.001) than those without the condition. Length of ICU stay (P = 0.004, OR = 1.253) and intracranial hypertension (P = 0.027, OR = 3.206) were independent risk factors for posttraumatic hypopituitarism.

Conclusions: The prevalence of anterior hypopituitarism was estimated to be 17.1%. Patients with intracranial hypertension and longer length of ICU stay are at risk of hypopituitarism. Routine pituitary function evaluation is indicated for this group of patients.

*Department of Neurosurgery

Department of Rehabilitation Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Address correspondence and reprint requests to Xiaofeng Yang, MD, Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China; E-mail: zjcswk@zju.edu.cn

Received 7 October, 2018

Accepted 13 January, 2019

W. You and Y. Zhu contributed equally to this work.

The authors declare no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.