Prevalence of Anterior Pituitary Dysfunction Twelve Months or More following Traumatic Brain Injury in Adults: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of non-randomized observational studies (cohort, case-control, and cross-sectional)
PubMed 31111791 · doi:10.1089/neu.2018.6349
What was done
Authors systematically searched Medline, Embase, and PubMed through April 2017 for cohort, case-control, and cross-sectional studies reporting anterior pituitary function at least 12 months post-TBI in adults (minimum 5 participants). Study quality was assessed with the Newcastle-Ottawa Scale (NOS) and the use of dynamic provocation testing for growth hormone and ACTH. Data from 29 studies (2,756 participants) were synthesized using random-effects meta-analysis.
What was found
The pooled prevalence of at least one anterior pituitary dysfunction across all 29 studies was 32% (95% CI 25–38%), and 34% (95% CI 27–42%) in the 12 high-quality studies (NOS > 8 and provocation testing). Significant between-study heterogeneity was present; studies with a higher proportion of mild TBI reported lower dysfunction prevalence.
Why it matters
Chronic hypopituitarism is common after TBI, affecting roughly one in three adult patients at or beyond one year, underscoring the need for routine endocrine evaluation.
Limits
Included studies were observational and varied widely in design (including cross-sectional cohorts). Significant heterogeneity persisted across studies, and exact axis-specific deficiency rates were not detailed in the abstract.
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