A Narrative Review on Posttraumatic Hypopituitarism; Part 1: Definitions, epidemiology, pathophysiology and clinical feature
Abstract
Posttraumatic hypopituitarism (PTHP) is a form of acquired hypopituitarism following traumatic brain injury (TBI). TBI is a common significant global health problem. TBI in its full range of severity can lead to hypopituitarism with consequent substantial impact on health and quality of life. We carried a narrative review of relevant cohort, case-control studies, systematic reviews, and meta-analyses since the year 2007 and after and published online in PubMed, EMBASE and Medline databases. The aim was to draw health care providers’ (HCPs’) attention to the existence of PTHP, and to raise their awareness about the approach to such cases. This review is divided into two parts; this part one covered the definitions, epidemiology, pathophysiology and clinical features of TBI and PTHP. The second part dealt with the predictors, diagnosis, treatment and prognosis of PTHP. We intervened by creation of two algorithms on investigations and treatment of PTHP (discussed in part 2 of this review). Results of this part of the review showed that road traffic accidents (RTAs), falls and child abuse are the major causes of brain injury. The age group vulnerable to TBI is 15 to 24 years with male preponderance. Different prevalence of PTHP derived by different studies are attributed to different methods and laboratory cut - off levels to diagnose hormone deficiencies. Africa and North America showed higher TBI incidence than central Asia, Central and Eastern Europe. Pathogenesis of PTHP is multifaceted intricate topic. Clinical manifestations of TBI may overlap with those of acute adrenal insufficiency during the acute phase of TBI. Awareness of the existence of PTHP should be further raised and maintained in the accidents and emergency departments.
Objectives: To review relevant manuscripts and narrate the data available on epidemiology, pathophysiology and clinical features of TBI and PTHP. This is to draw HCP’s attention to the existence of PTHP and how it manifest during different phases of TBI. This is to enable them approach PTHP cases in a timely manner.
Methods: We searched PubMed, EMBASE and Medline databases using the words prevalence, incidence, brain injury, hypopituitarism, pathophysiology and clinical features. We narrated the literature derived from this search of manuscripts of cohort, case-control studies, systematic reviews and meta-analyses relevant to this topic
Results: By reviewing the epidemiology of TBI and PTHP we found PTHP is existing with different prevalence. Road traffic accidents (RTAs), falls and child abuse are the major causes of brain injury. Prevalence differs by geographic area, gender and age. Pathogenesis is complicated.
How to cite this: Mohammed AME, Wanjiru AW, Tsishutsina V. A Narrative Review on Posttraumatic Hypopituitarism; Part 1: Definitions, epidemiology, pathophysiology and clinical feature. JPES. 2024;1(2):69-82.
