Mohd Salleh Nurshaheda, Theophilus Sharon Casilda, Rahman Noor Azman A, Ghani Abdul Rahman Izaini, Abdullah Jafri Malin, Idris Zamzuri, Tan Zi Han, Kamil Nur Muhammad
Department of Neurosurgery, Hospital Sultanah Aminah, Johor, Malaysia.
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
Malays J Med Sci. 2023 Feb;30(1):107-115. doi: 10.21315/mjms2023.30.1.9. Epub 2023 Feb 28.
Hypopituitarism following traumatic brain injury (TBI) is not rare however most patients were left undiagnosed and untreated. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. The aim of the study is to determine the incidence of the chronic anterior pituitary deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction.
This is single centre cross-sectional study involved 105 traumatic head injury patients under the Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru, Malaysia. The primary investigator will do an interview and the patients will be asked question to complete a questioner from SF-36 (36 questions). Subsequently, consent for participation will be taken and blood sampling will be done.
Thirty-three patients were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old. Twenty-seven patients (32.5%) were male and six patients were female (27.3%). Chronic anterior pituitary dysfunction in patients with a severe traumatic head injury around 47.1% (23 patients), as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 ± 1.79 months. All patient with anterior pituitary dysfunction had positive CT brain findings with 22 had subarachnoid haemorrhage (SAH) at the basal cistern and 27 patients had a base of skull fracture, where 52.1% of the patient underwent surgical intervention, 84.8% involved one axis and another 5 patients had two axes involved. Severity of the head injury ( < 0.001), prolonged duration of hospital stay ( = 0.014), radiological findings of a base of skull fracture ( < 0.001) and presence of SAH at basal cistern ( < 0.001) was significantly associated with pituitary dysfunction. The patient with anterior pituitary dysfunction has the lower 36-item Short Form Survey (SF-36) marks 56.3 ± 10.3.
The prevalence of hypopituitarism was 31%. Indicators are increased TBI severity, prolonged hospitalisation and positive finding in radiological assessment. Post-traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF-36 marks.
创伤性脑损伤（TBI）后垂体功能减退并不罕见，但大多数患者未被诊断和治疗。TBI后垂体功能减退与神经行为和生活质量受损有关。本研究的目的是确定创伤性脑损伤患者慢性垂体前叶功能减退的发生率。随后确定慢性垂体前叶功能障碍患者的危险因素和预后。
这是一项单中心横断面研究，涉及马来西亚柔佛州新山市苏丹娜阿敏娜医院神经外科的105名创伤性颅脑损伤患者。主要研究者将进行访谈，并向患者提问以完成SF-36（36个问题）问卷。随后，将获取患者的参与同意书并进行血液采样。
33名患者被发现有垂体前叶功能障碍。平均年龄为36.97±12.96岁。27名患者（32.5%）为男性，6名患者为女性（27.3%）。重度创伤性颅脑损伤患者中慢性垂体前叶功能障碍的发生率约为47.1%（23例），中度颅脑损伤患者为8例（38.1%），2例轻度颅脑损伤患者为5.6%。创伤发作后的平均持续时间为10.3±1.79个月。所有垂体前叶功能障碍患者的脑部CT检查结果均为阳性，22例患者基底池有蛛网膜下腔出血（SAH），27例患者有颅底骨折，其中52.1%的患者接受了手术干预，84.8%的患者涉及一个轴，另外5例患者涉及两个轴。颅脑损伤的严重程度（<0.001）、住院时间延长（=0.014）、颅底骨折的影像学表现（<0.001）以及基底池SAH的存在（<0.001）与垂体功能障碍显著相关。垂体前叶功能障碍患者的36项简短问卷调查（SF-36）得分较低，为56.3±10.3。
垂体功能减退的患病率为31%。指标包括TBI严重程度增加、住院时间延长以及影像学评估结果阳性。创伤后慢性垂体前叶功能障碍也与生活质量差有关，如SF-36得分低所示。
