Neuroendocrine Dysfunction in the Acute Setting of Penetrating Brain Injury: A Systematic Review

World Neurosurg. 2021 Mar;147:172-180.e1. doi: 10.1016/j.wneu.2020.12.058. Epub 2020 Dec 17.

Abstract

Background: Data on neuroendocrine dysfunction (NED) in the acute setting of penetrating brain injury (PBI) are scarce, and the clinical approach to diagnosis and treatment remains extrapolated from the literature on blunt head trauma.

Methods: Three databases were searched (PubMed, Scopus, and Cochrane). Risk of bias was computed using the Newcastle-Ottawa Scale, or the methodological quality of case series and case reports, as indicated. This systematic review was registered in PROSPERO (42020172163).

Results: Six relevant studies involving 58 patients with PBI were included. Two studies were prospective cohort analyses, whereas 4 were case reports. The onset of NED was acute in all studies, by the first postinjury day. Risk factors for NED included worse injury severity and the presence of cerebral edema on imaging. Dysfunction of the anterior hypophysis involved the hypothalamic-pituitary-thyroid axis, treated with hormonal replacement, and hypocortisolism, treated with hydrocortisone. The prevalence of central diabetes insipidus was up to 41%. Most patients showed persistent NED months after injury. In separate reports, diabetes insipidus and hypocortisolism showed an association with higher mortality. The available literature for this review is poor, and the studies included had overall low quality with high risk of bias.

Conclusions: NED seems to be prevalent in the acute phase of PBI, equally involving both anterior and posterior hypophysis. Despite a potential association between NED and mortality, data on the optimal management of NED are limited. This situation defines the need for prospective studies to better characterize the clinical features and optimal therapeutic interventions for NED in PBI.

Keywords: Neurocritical care; Neuroendocrine dysfunction; Penetrating brain injury.

Publication types

  • Systematic Review

MeSH terms

  • Acute Disease
  • Adrenal Insufficiency / drug therapy
  • Adrenal Insufficiency / epidemiology*
  • Adrenal Insufficiency / physiopathology
  • Brain Edema
  • Brain Injuries / epidemiology*
  • Brain Injuries / physiopathology
  • Diabetes Insipidus, Neurogenic / drug therapy
  • Diabetes Insipidus, Neurogenic / epidemiology*
  • Diabetes Insipidus, Neurogenic / physiopathology
  • Head Injuries, Closed / epidemiology
  • Head Injuries, Closed / physiopathology
  • Head Injuries, Penetrating / epidemiology*
  • Head Injuries, Penetrating / physiopathology
  • Humans
  • Hypopituitarism / drug therapy
  • Hypopituitarism / epidemiology*
  • Hypopituitarism / physiopathology
  • Hypothalamo-Hypophyseal System
  • Hypothyroidism / drug therapy
  • Hypothyroidism / epidemiology*
  • Hypothyroidism / physiopathology
  • Injury Severity Score
  • Mortality
  • Pituitary-Adrenal System
  • Prevalence
  • Prognosis
  • Thyroid Gland