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Prevalence of Anterior Pituitary Dysfunction Twelve Months or More following Traumatic Brain Injury in Adults: A Systematic Review and Meta-Analysis
Abstract
The objective of this study is to systematically review clinical studies that have reported on the prevalence of chronic post–traumatic brain injury anterior pituitary dysfunction (PTPD) 12 months or more following traumatic brain injury (TBI). We searched Medline, Embase, and PubMed up to April 2017 and consulted bibliographies of narrative reviews. We included cohort, case–control, and cross-sectional studies enrolling at least five adults with primary TBI in whom at least one anterior pituitary axis was assessed at least 12 months following TBI. We excluded studies in which other brain injuries were indistinguishable from TBI. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) score. We also considered studies that determined growth hormone deficiency and adrenocorticotrophic hormone reserve using provocation test to be at low risk of bias. Data were extracted by four independent reviewers and assessed for risk of bias using a data extraction form. We performed meta-analyses using random effect models and assessed heterogeneity using the I 2 index. We identified 58 publications, of which 29 (2756 participants) were selected for meta-analysis. Twelve of these were deemed to be at low risk of bias and therefore “high-quality,” as they had NOS scores greater than 8 and had used provocation tests. The overall prevalence of at least one anterior pituitary hormone dysfunction for all 29 studies was 32% (95% confidence interval [CI] 25–38%). The overall prevalence in the 12 high-quality studies was 34% (95% CI 27–42%). We observed significant heterogeneity that was not solely explained by the risk of bias. Studies with a higher proportion of participants with mild TBI had a lower prevalence of PTPD. Our results show that approximately one-third of TBI sufferers have persistent anterior pituitary dysfunction 12 months or more following trauma. Future research on PTPD should differentiate between mild and moderate/severe TBI.
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“Moreover, the lack of specific guidelines for hypopituitarism assessments in patients with previous TBI, also concerning long-term follow-up and serial check-ups, may result in missed or late diagnosis with potentially severe consequences [11,12,13].”
From An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges (2023) · cites this paper as [12]
In the citing paper
“In pre-pubertal and pubertal individuals, the isolated presence of GH deficiency can be the cause of permanent short stature with severe consequences in the absence of prompt diagnosis and growth hormone administration due to the effect of sex hormones on the growth plate, which will determine the epiphyseal closure [12,38,51,52,53,56].”
From An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges (2023) · cites this paper as [12]
In the citing paper
“However, in the last two decades, numerous studies demonstrated that TBI-related hypopituitarism is frequently found among survivors of TBI [16], with a pooled prevalence of 27% in a meta-analysis that included 19 studies [12,38,51,52,53].”
From An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges (2023) · cites this paper as [12]
In the citing paper
“In adults, TBI can lead to endocrinopathies (endocrine system disorders), but this is infrequently reported in children.”
From Epidemiology of Pediatric Traumatic Brain Injury and Hypothalamic-Pituitary Disorders in Arizona (2020) · cites this paper as [8]
In the citing paper
“A recent meta-analysis that included data from 2,756 adult TBI patients reported a 32% overall prevalence of at least one endocrine diagnosis after TBI (8).”
From Epidemiology of Pediatric Traumatic Brain Injury and Hypothalamic-Pituitary Disorders in Arizona (2020) · cites this paper as [8]
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An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges
Vlad, R. M., Albu, A. I., Nicolaescu, I. D., Dobritoiu, R., Carsote, M., Sandru, F., Albu, D., & Păcurar, D. (2023) · Diagnostics · doi:10.3390/diagnostics13020212 · Cited by 7
Metadata
- Authors
- Emelifeonwu, J. A., Flower, H., Loan, J. J., McGivern, K., & Andrews, P. J. D.
- Affiliations
- Department of Neurosurgery, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom.
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom.
- Department of Neurosurgery, NHS Lothian Western General Hospital, Edinburgh, United Kingdom.
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
- Center for Clinical Brain Sciences, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2019-12-20
- Volume
- 37
- Issue
- 2
- Pages
- 217-226
- ISSN
- 0897-7151
- 1557-9042
- Cited by
- 55
- References
- 30
- Language
- en
- Licence
- journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
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