Pattern of pituitary gland injuries in fatal head injuries: A cross-sectional autopsy study

Pituitary gland injury following traumatic brain injury (TBI) is an increasingly recognised but underdiagnosed complication with significant clinical and forensic implications. Morphological data from Asian autopsy series remain scarce. This study aimed to estimate the frequency and histopathological pattern of pituitary gland injuries in fatal head injury cases and to correlate these findings with associated craniocerebral injuries and post-injury survival time.

A cross-sectional autopsy study of 150 consecutive fatal head injury cases was conducted at a tertiary care forensic medicine institute in South India between February 2021 and August 2022. The pituitary gland was retrieved at autopsy, fixed in 10% neutral buffered formalin, sectioned in three planes, embedded in paraffin, cut at 6 μm, and stained with haematoxylin and eosin. Histological assessment was performed by a single forensic pathologist who was blinded to all clinical, circumstantial, and survival data at the time of microscopic examination. Gross and histopathological findings were correlated with craniocerebral injuries and post-injury survival time using descriptive statistics, stepwise logistic regression (reporting odds ratios [OR] with 95% confidence intervals [CI], Nagelkerke R², and Hosmer-Lemeshow goodness-of-fit), and chi-square tests.

Males constituted 74% and the commonest age group was 31-40 years (44%). Road traffic accidents accounted for 68.67% of cases. Histopathologically, 68 cases (45.33%) showed pituitary injury. The stalk was most frequently affected (haemorrhage 40.7%), followed by the posterior lobe (35.3%) and anterior lobe (30%). No individual craniocerebral injury subtype was independently associated with pituitary injury (all P > 0.05; OR range 0.89-1.44). Pituitary haemorrhage predominated in early deaths (≤48 h), whereas necrosis characterised late deaths (>48 h).

Pituitary gland injury is present in nearly half of fatal head injury cases. The histopathological pattern-haemorrhage versus necrosis-correlates with the post-injury survival interval and may, pending independent validation, serve as a useful forensic indicator at autopsy. These findings underscore the need for prospective studies in TBI survivors to evaluate pituitary function and inform clinical management.