Prevalence and Predictors of Hypopituitarism Following Traumatic Brain Injury: A Prospective Observational Study

Abstract

Posttraumatic hypopituitarism (PTHP) is an increasingly recognized complication of traumatic brain injury (TBI) and may contribute to delayed neurological recovery, persistent fatigue, cognitive dysfunction, and poor rehabilitation outcomes. Although global literature reports a variable prevalence, data from Indian trauma populations remain limited and routine endocrine screening after TBI is not uniformly practiced.

To determine the prevalence, temporal evolution, and predictors of hypopituitarism following TBI in adults treated at a tertiary care center.

This prospective observational study included adult patients with mild, moderate, and severe TBI. Hormonal evaluation of the hypothalamic– pituitary axis was performed during the acute phase and at 3, 6, and 12 months of follow-up to predict the prevalence of hypopituitarism. Clinical parameters including the Glasgow Coma Scale, pupillary abnormalities, ventilatory requirement, and radiological parameters, such as type of intracranial injury, presence of skull base fractures, diffuse axonal injury (DAI), and Marshall computed tomography classification, were recorded and statistically analyzed to find their correlation with hypopituitarism, so as to predict its outcome. Statistical analysis was performed using the Chi-square test or Fisher's exact test, with p-value <0.05 considered significant.

Of 61 patients enrolled, 55 completed follow-up. Hypopituitarism was detected in 18 patients (32.7%) during the acute phase, declining to 9 (16.4%) at 3 months and persisting in 7 patients (12.7%) at both 6 and 12 months. Hypocortisolism was the most common acute abnormality, while hyperprolactinemia predominated during follow-up. Skull base fracture demonstrated a consistent and statistically significant association with hypopituitarism at 3 months (p = 0.039), 6 months (p = 0.001), and 12 months (p = 0.001). DAI and epidural hematoma were significantly associated at 6 months (p = 0.004). No significant association was observed with any other head injury–related parameter.

PTHP is common following TBI, with persistent endocrine dysfunction in a significant subset of patients up to 1 year. Skull fracture is a reliable predictor of long-term pituitary dysfunction. Focused endocrine screening in high-risk TBI patients may facilitate early detection and improve long-term outcomes.