Pituitary Hormonal Imbalance after Moderate to Severe Traumatic Brain Injury Patients: Analytical Prospective Study

Abstract Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. In Egypt moderate and severe TBI represents 17.2% of presenting cases. The frequency of hypopituitarism after TBI varies widely among different studies (15-50% of the patients with TBI in most studies. Aim of Study: The aim of this study is to estimate the prevalence of pituitary hormonal imbalance in moderate to severe Traumatic Brain Injury (TBI) patients in Egypt. Patients and Methods: Analytical prospective study with sample size of 23 patients admitted in Cairo University Hospitals from December 2020 to April 2021 with our inclusion criteria. Hormonal Assay level was used to detect Hormonal deficiency. Serum ACTH, Morning Cortisol, TSH, LH, FSH, and GH were measured within 24 hrs. from time of trauma and follow-up after 2 weeks, 1 month and 2 months and stratified according to matching Age and sex. Results: Out of the 23 included in the study 6 patients (26%) were found to have pituitary hormonal imbalance; 2 patients (8.7%) have GH deficiency, 2 patients (8.7%) with ACTH/cortisol deficiency, one patient (4.35%) with LH deficiency and one patient (4.35 %) with TSH deficiency and one of affected patients with increased urine output (CDI). Overall age ranged from 2 years to 40 years with a mean age 12.1 years ±  7.74 Years. 15 patients (65.2%) were males and 8 patients (34.8%) were females. Out from 6 patients that have NED, 4 patients (66.7%) had severe head, 2 patients (33.3%) had moderate head injury. Out of 6 patients that have NED 2 patients (33.3%) underwent conservative treatment and 4 patients (66.6%) underwent neurosurgical intervention. Conclusion: Pituitary hormonal imbalance is one of the long term sequelae of traumatic Brain injury. Many patients are under-diagnosed because symptoms of mild hypopituitarism are slowly developing. Growth Hormone and ACTH are the most frequent pituitary hormone deficiencies in patients who have sustained TBI. It should not be underestimated because hormonal abnormalities may contribute to a diminished quality of life.