Predictors of Hypopituitarism in Patients with Traumatic Brain Injury

J Neurotrauma. 2015 Nov 15;32(22):1789-95. doi: 10.1089/neu.2015.3998. Epub 2015 Sep 29.


Hypopituitarism may often occur in association with traumatic brain injury (TBI). Identification of reliable predictors of pituitary dysfunction is of importance in order to establish a rational testing approach. We searched the records of patients with TBI, who underwent neuroendocrine evaluation in our institution between 2007 and 2013. One hundred sixty-six adults (70% men) with TBI (median age: 41.6 years; range: 18-76) were evaluated at a median interval of 40.4 months (0.2-430.4).Of these, 31% had ≥1 pituitary deficiency, including 29% of patients with mild TBI and 35% with moderate/severe TBI. Growth hormone deficiency was the most common deficiency (21%); when body mass index (BMI)-dependent cutpoints were used, this was reduced to 15%. Central hypoadrenalism occurred in10%, who were more likely to have suffered a motor vehicle accident (MVA, p = 0.04), experienced post-traumatic seizures (p = 0.04), demonstrated any intracranial hemorrhage (p = 0.05), petechial brain hemorrhages (p = 0.017), or focal cortical parenchymal contusions (p = 0.02). Central hypothyroidism occurred in 8% and central hypogonadism in 12%; the latter subgroup had higher BMI (p = 0.03), were less likely to be working after TBI (p = 0.002), and had lower Global Assessment of Functioning (GAF) scores (p = 0.03). Central diabetes insipidus (DI) occurred in 6%, who were more likely to have experienced MVA (p < 0.001) or sustained moderate/severe TBI (p < 0.001). Patients with MVA and those with post-traumatic seizures, intracranial hemorrhage, petechial brain hemorrhages, and/or focal cortical contusions are at particular risk for serious pituitary dysfunction, including adrenal insufficiency and DI, and should be referred for neuroendocrine testing. However, a substantial proportion of patients without these risk factors also developed hypopituitarism.

Keywords: adrenal insufficiency; diabetes insipidus; growth hormone deficiency; hypogonadism; hypopituitarism; hypothyroidism; traumatic brain injury.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Accidents, Traffic
  • Adolescent
  • Adrenal Insufficiency / etiology
  • Adult
  • Aged
  • Body Mass Index
  • Brain Hemorrhage, Traumatic / etiology
  • Brain Hemorrhage, Traumatic / pathology
  • Brain Injuries / complications*
  • Brain Injuries / pathology
  • Cerebral Cortex / pathology
  • Diabetes Insipidus
  • Female
  • Human Growth Hormone / deficiency
  • Humans
  • Hypogonadism / etiology
  • Hypogonadism / pathology
  • Hypopituitarism / etiology*
  • Hypopituitarism / pathology
  • Hypothyroidism / etiology
  • Hypothyroidism / pathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Seizures / etiology
  • Tomography, X-Ray Computed
  • Young Adult


  • Human Growth Hormone