Risk Factors for Anterior Hypopituitarism in Patients With Traumatic Brain Injury.

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.