title: Predictors of post-traumatic pituitary failure during  long-term follow-up.
abstract: OBJECTIVE
  There is increasing awareness among physicians of the risks of traumatic brain injury (TBI)-induced hypopituitarism. We have assessed the prevalence and risk factors of post-traumatic hypopituitarism by analyzing the TBI database of the University of Pecs.
  
  
  METHODS
  This consecutive analysis of 126 TBI survivors (mean age: 42.4 years, average follow-up time: 48 months) revealed that 60.3% had severe and 39.7% moderately severe trauma based on GCS score. Subdural hemorrhage (29.3%) and diffuse injury (27%) were the most common types of injury; 17.5% of patients suffered basal skull fractures.
  
  
  RESULTS
  The prevalence of major anterior pituitary failure was 57.1%. Occurrence of total and partial growth hormone deficiency (GHD/GHI) was 39.7%, while LH/FSH, TSH and ACTH deficiencies were less frequent, namely 23.0%, 16.7% and 10.3%, respectively. Of the 82 patients with multiple endocrine evaluations, 31.7% presented significant changes in hormonal deficiencies during the follow-up period: new hormone deficiencies developed in 16 patients, while hormonal disturbances resolved in 10 subjects. Looking for factors influencing the prevalence of pituitary dysfunction, endocrine results were analyzed in relation to age, gender, GCS scores, injury types, basal skull fracture, ventricular drain insertion and necessity of neurosurgical intervention. All hormonal disturbances were more prevalent after severe trauma (OR: 3.25, p=0.002), while the need for surgery proved to be an independent determinant of multiple and GH deficits (OR: 3.72 (p=0.004) and 9.33 (p=0.001)).
  
  
  CONCLUSIONS
  Post-traumatic hypopituitarism is common and may evolve or resolve over time. Victims of severe TBI and/or patients who have undergone neurosurgical intervention for head injury are the most prone to post-traumatic hypopituitarism.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Nemes
authors.forename: Noemi
authors.initials: N
authors.lastname: Kovacs
authors.forename: Endre
authors.initials: E
authors.lastname: Czeiter
authors.forename: Peter
authors.initials: P
authors.lastname: Kenyeres
authors.forename: Zita
authors.initials: Z
authors.lastname: Tarjanyi
authors.forename: Laszlo
authors.initials: L
authors.lastname: Bajnok
authors.forename: Andras
authors.initials: A
authors.lastname: Buki
authors.forename: Tamas
authors.initials: T
authors.lastname: Doczi
authors.forename: Emese
authors.initials: E
authors.lastname: Mezosi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult