Pituitary gland trauma in fatal nonsurgical closed traumatic brain injury

Traumatic injury to pituitary gland can lead to significant endocrine dysfunctions. The aim of this study is to define the frequency of pituitary gland injury in patients with fatal nonsurgical closed traumatic brain injury (TBI), and to correlate if any, the type of craniocerebral injury associated with the pituitary gland injury.

The study is a prospective autopsy review of 30 adult patients with fatal closed TBI. Patients who had any form of neurosurgical intervention were excluded from the study. The harvested pituitary glands were assessed morphologically and histologically with haematoxylin-eosin stains.

There were 25 males and five females (median age: 35 years). Fatal closed TBI was associated with at least pituitary stalk rupture or pituitary gland haemorrhage in 13 patients (43.3%). There was significant relationship between subdural haemorrhage (SH) and either pituitary gland haemorrhage or pituitary stalk rupture. Odds ratio (OR) of a patient with SH having accompanying glandular pituitary haemorrhage was 21 while the OR of a patient with SH having pituitary stalk rupture was 12.

Pituitary gland haemorrhage and stalk rupture frequency are fairly common in fatal closed TBI that do not require surgical intervention. Injury to both structures probably plays substantial roles in closed TBI outcome. We suggest routine assessment of pituitary gland function test in patients with closed TBI associated with SH.