Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury.
OBJECTIVE
The objective was to study the anatomical changes in the pituitary gland following acute moderate or severe traumatic brain injury (TBI).


METHODS
Retrospective, observational, case-control study.


METHODS
Neurosciences Critical Care Unit of a university hospital.


METHODS
Forty-one patients with moderate or severe TBI who underwent magnetic resonance imaging (MRI) during the acute phase (less than seven days) of TBI. MRI scans of 43 normal healthy volunteers were used as controls.


METHODS
None.


RESULTS
Patient demographics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Injury Severity Score (ISS), post-resuscitation Glasgow Coma Score (GCS), Glasgow Outcome Score (GOS), mean intracranial pressure (ICP), mean cerebral perfusion pressure (CPP), computed tomography (CT) data, pituitary gland volumes and structural lesions in the pituitary on MRI scans. The pituitary glands were significantly enlarged in the TBI group (the median and interquartile range were as follows: cases 672 mm3 (range 601-783 mm3) and controls 552 mm3 (range 445-620 mm3); p value<0.0001). APACHE II, GCS, GOS and ICP were not significantly correlated with the pituitary volume. Twelve of the 41 cases (30%) demonstrated focal changes in the pituitary gland (haemorrhage/haemorrhagic infarction (n=5), swollen gland with bulging superior margin (n=5), heterogeneous signal intensities in the anterior lobe (n=2) and partial transection of the infundibular stalk (n=1).


CONCLUSIONS
Acute TBI is associated with pituitary gland enlargement with specific lesions, which are seen in approximately 30% of patients. MRI of the pituitary may provide useful information about the mechanisms involved in post-traumatic hypopituitarism.
University Division of Anaesthesia, Cambridge University Foundation Hospitals NHS Trust, Hills Road, Box 93, CB2 2QQ Cambridge, Cambridgeshire, UK. bm331@cam.ac.uk
Balachandra
B
Maiya
Virginia
V
Newcombe
Jurgens
J
Nortje
Peter
P
Bradley
Francis
F
Bernard
Dot
D
Chatfield
Joanne
J
Outtrim
Peter
P
Hutchinson
Basil
B
Matta
Nagui
N
Antoun
David
D
Menon
D018806:APACHE; D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000473:pathology*; D016022:Case-Control Studies; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology / Q000473:pathology*; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010903:Pituitary Gland, Anterior / Q000473:pathology*; D012189:Retrospective Studies