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

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY
R. Midhunraj , Saifullah Khalid , Mohd. Khalid , Hamid Ashraf , Abul Bashar Mohammad Kamrul-Hasan
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Abstract

Introduction

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.

Materials and methods

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.

Results

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).

Discussion

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.
创伤性脑损伤严重程度对垂体前叶功能影响的前瞻性研究
印度是全球道路交通死亡人数最多的国家。获得性垂体功能减退症是创伤性脑损伤(TBI)患者常见的后遗症。本研究旨在调查在印度北部三级保健中心的TBI患者中垂体功能低下的患病率和影像学特征。材料和方法一项前瞻性研究包括76例TBI患者(轻度、中度或重度),我们在印度北部的一家三级保健中心对他们进行了24周的随访。所有纳入的受试者在基线和24周时再次接受垂体前激素(LH, FSH, TSH, T4,皮质醇,睾酮,雌激素)评估,并进行MRI检查。对皮质醇水平较低的受试者进行胰高血糖素刺激试验,刺激后测量皮质醇和生长激素水平。我们记录了所有患者的颅脑外伤严重程度、CT扫描结果(如颅骨骨折)和脑垂体成像特征。适当的统计分析,包括逻辑回归,被用来确定垂体功能减退的决定因素。结果76例患者急性期垂体功能低下患病率为11.84 %,24周时为2.63 %。垂体功能减退与损伤严重程度(p <; 0.001)和MRI成像异常显著相关。MRI主要表现为信号不均匀、垂体前叶亚急性出血、垂体高度降低。从基线到24周,LH (p = 0.009)和FSH (p = 0.039)水平有统计学意义的下降。损伤的严重程度和颅底骨折的存在与垂体功能低下显著相关(p <; 0.001)。我们的研究结果强调了在TBI患者中检查垂体功能的重要性,特别是那些有中重度损伤和颅底骨折的患者,可以快速发现和治疗激素缺乏,这可以改善长期疗效。未来的研究应集中在更长的随访期和更复杂的成像方法上,以更深入地了解创伤后垂体功能减退的机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery 医学-临床神经学
CiteScore
3.70
自引率
5.30%
发文量
358
审稿时长
46 days
期刊介绍: Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.
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