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Neuroendocrine Dysfunction in the Acute Setting of Penetrating Brain Injury: A Systematic Review
Andrea Loggini1, Ruth Tangonan1, Faten El Ammar1
1Neuroscience Intensive Care Unit, Department of Neurology, University of Chicago Medical Center, Chicago, Illinois, USA.
World Neurosurgery
|December 21, 2020
Summary
Neuroendocrine dysfunction (NED) is common after penetrating brain injury (PBI), affecting both anterior and posterior pituitary function. Further research is needed to understand optimal management strategies for this condition.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Trauma Care
Background:
- Limited data exist on neuroendocrine dysfunction (NED) in acute penetrating brain injury (PBI).
- Current clinical approaches are extrapolated from blunt head trauma literature.
- This highlights a significant knowledge gap in managing PBI patients.
Purpose of the Study:
- To systematically review the existing literature on neuroendocrine dysfunction in the acute setting of penetrating brain injury.
- To identify prevalence, risk factors, and potential associations with mortality.
- To inform future research directions.
Main Methods:
- Systematic review of three databases (PubMed, Scopus, Cochrane).
- Risk of bias assessed using the Newcastle-Ottawa Scale or similar methods for case series/reports.
- PROSPERO registration (42020172163).
Main Results:
- Six studies with 58 PBI patients were included; onset of NED was acute (by day 1 post-injury).
- Risk factors included injury severity and cerebral edema; anterior hypophysis dysfunction (e.g., thyroid axis, hypocortisolism) and central diabetes insipidus (up to 41%) were observed.
- NED often persisted post-injury, with diabetes insipidus and hypocortisolism potentially linked to higher mortality. Study quality was generally low.
Conclusions:
- Neuroendocrine dysfunction appears prevalent in acute PBI, affecting both anterior and posterior pituitary.
- Despite potential mortality links, optimal NED management data are scarce.
- Prospective studies are crucial to characterize PBI-related NED and guide therapeutic interventions.
