Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Many sufferers never return to their pre-injury level of function and have life-long health and socioeconomic problems that limit their daily activities. In the last two decades there has been renewed interest in whether post-TBI anterior pituitary dysfunction (PTPD) contributes to morbidity.
The PhD focuses on patients with mild TBI (mTBI). My aims are to explore the scientific evidence for PTPD including its prevalence in the TBI population and how it is currently managed by Neurosurgeons in Great Britain and Ireland. I also performed a prospective, feasibility study to determine if a larger study of the acute and long-term effects of isolated mTBI on anterior pituitary function was deliverable. Pilot data are presented in this thesis.
Our systematic review demonstrated that PTPD occurs in one-third of patients 12 months after TBI and we found disparities in surveillance practices across the UK and Ireland. We demonstrated in our feasibility study that 44% of patients have abnormal anterior pituitary hormone activity in the first 7 days following mTBI and 20% of patients who were followed up at 6 months had evidence of PTPD. We found no evidence that PTPD occurs as a result of structural damage to the anterior pituitary gland, suggesting other, yet to be determined factors play a role. A large, prospective, multi-centre study is needed to better understand the pathophysiology and incidence of PTPD
