Impact of traumatic brain injury severity on anterior pituitary function: A prospective study

India experiences the highest number of road traffic fatalities globally. Acquired hypopituitarism is a common sequela in patients who sustain traumatic brain injury (TBI). This study aimed to investigate the prevalence and imaging characteristics of hypopituitarism in patients with TBI at a tertiary care centre in North India.

Our prospective study included 76 patients with TBI (mild, moderate, or severe), whom we followed for 24 weeks at a tertiary care centre in North India. All included subjects underwent assessments of anterior pituitary hormones (LH, FSH, TSH, T4, cortisol, testosterone, estrogen) at baseline and again at 24 weeks, as well as an MRI. Those who had low cortisol level were subjected to glucagon stimulation test and cortisol and growth hormone was measured after stimulation in these subjects. We recorded the severity of traumatic brain injury, findings from CT scans such as skull fractures, and imaging characteristics of pituitary gland in all the patients by magnetic resonance imaging (MRI). Appropriate statistical analyses, including logistic regression, were utilized to determine the determinants of hypopituitarism.

Among the 76 patients, the prevalence of hypopituitarism was 11.84 % in the acute stage and 2.63 % at 24 weeks. Hypopituitarism significantly correlated with injury severity (p < 0.001) and imaging abnormalities observed on MRI. The main imaging findings on MRI were heterogeneous signal intensity, subacute haemorrhage in the anterior pituitary, and reduced pituitary height. A statistically significant decrease was observed in LH (p = 0.009) and FSH levels (p = 0.039) from baseline to 24 weeks. The severity of the injury and the presence of base skull fractures were significantly associated with hypopituitarism (p < 0.001).

Our results highlight the importance of checking pituitary function in TBI patients, particularly those with moderate to severe injuries and skull base fractures, to quickly find and treat hormonal deficiencies, which can improve long-term results. Future studies should concentrate on longer follow-up periods and more sophisticated imaging methods to gain a more profound understanding of the mechanisms underlying post-traumatic hypopituitarism.