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Meta-Analysis
. 2024 Nov 11;47(1):841.
doi: 10.1007/s10143-024-03088-3.

Acute and chronic hypopituitarism following traumatic brain injury: a systematic review and meta-analysis

Ghaith S Aljboor  1   2 , Aoun Tulemat  3 , Ali Ridha Al-Saedi  3 , Mugurel Petrinel Radoi  3   4 , Corneliu Toader  3   4 , Toma Marius Papacocea  3   5
Affiliations
Meta-Analysis

Acute and chronic hypopituitarism following traumatic brain injury: a systematic review and meta-analysis

Ghaith S Aljboor et al. Neurosurg Rev. .

Abstract

Traumatic brain injury (TBI) is associated with various endocrine abnormalities, including pituitary axis dysfunction. Understanding the prevalence and temporal patterns of these dysfunctions is crucial for effective clinical management. This study aimed to systematically review the literature and conduct a meta-analysis to determine the prevalence of pituitary axis dysfunction following TBI, assess temporal patterns across different post-injury durations, and identify potential contributing factors. A comprehensive search was conducted across multiple electronic databases between 1st of January 2000 until 31st March 2024. Studies reporting the prevalence of pituitary axis dysfunction post-TBI were included. Pooled estimates with 95% confidence intervals (CIs) were calculated using random-effects models in the R statistical software. Subgroup analyses were performed based on duration post-TBI (< 3 months, 3-6 months, 6-12 months, > 12 months) to explore temporal variations. Heterogeneity was assessed using the I^2 statistic. A total of 52 studies were included in the meta-analysis, encompassing 7367 participants. The pooled estimate for the prevalence of any pituitary axis dysfunction post-TBI was 33% (95% CI [28%; 37%]). Subgroup analysis by duration revealed varying prevalence rates: < 3 months (40%, 95% CI [27%; 53%]), 3-6 months (31%, 95% CI [15%; 47%]), 6-12 months (26%, 95% CI [19%; 33%]), and > 12 months (32%, 95% CI [26%; 38%]). Prevalence of multiple axes affection was 7% (95% CI [6%; 9%]), with varying rates across durations. Specific axes affection varied: Growth Hormone (GH) deficiency was 18% (95% CI [14%; 21%]), adrenocorticotropic hormone (ACTH) deficiency was 10% (95% CI [8%; 13%]), pituitary-gonadal axis hormones deficiency was 16% (95% CI [12%; 19%]), and thyroid-stimulating hormone (TSH) deficiency was 6% (95% CI [5%; 7%]). This meta-analysis highlights a significant prevalence of pituitary axis dysfunction following TBI, with temporal variations observed across different post-injury durations. The findings underscore the importance of tailored clinical management strategies based on the duration and type of dysfunction. Further research addressing potential contributing factors is warranted to enhance understanding and management of these conditions.

Keywords: Endocrine abnormalities; Meta-analysis; Pituitary axis dysfunction; Prevalence; Temporal patterns; Traumatic brain injury.

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Conflict of interest statement

Declarations Ethical approval Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for summary of search and screening processes
Fig. 2
Fig. 2
Forest plot of the pooled prevalence of any axis affection (n = 52)
Fig. 3
Fig. 3
Forest plot of the pooled prevalence of multiple axes affection (n = 36)
Fig. 4
Fig. 4
Forest plot of the pooled prevalence of growth hormone deficiency (n = 46)
Fig. 5
Fig. 5
Forest plot of the pooled prevalence of adrenocorticotrophic hormone deficiency (n = 47)
Fig. 6
Fig. 6
Forest plot of the pooled prevalence of pituitary–gonadal axis hormones deficiency (n = 45)
Fig. 7
Fig. 7
Forest plot of the pooled prevalence of TSH deficiency (n = 45)
See this image and copyright information in PMC

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