Salleh, Nurshaheda Mohd (2020) Chronic anterior pituitary dysfunction following traumatic head injury: Prospective study in Hospital Sultanah Aminah Johor Bahru. Masters thesis, Universiti Sains Malaysia.
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Abstract
Background and Objective Traumatic brain injury(TBI) is associated with increase morbidity, mortality and long term disability. Hypopituitarism following TBI is not rare and most patient had undiagnosed and untreated hypopituitarism. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. There are wide range of post-traumatic hypopituitarism (PTHP) has been reported ranging 10-58%. 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. Methods This is the single centre prospective cross-sectional study where 105 traumatic head injury patients under Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru follow up who fulfilled the inclusion criteria. The inclusion criteria were patient with traumatic head injury, age from 18 to 65-year-old and had history of trauma 3 month prior to enrolment. The exclusion criteria were traumatic brain injury patient in chronic vegetative state with low life expectancy, patient who diagnosed or taking hormonal replacement therapy prior to the trauma, pregnant woman and female patient with normal menses LH and FSH will not be taken. The primary investigator will do an interview with the patient and the patient will be asked question to complete questioner form (36 question). Subsequently, blood sampling will be done. Other demographic data will be required from the admission documents. Results A total 33 patients (31%) were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old with a median of 35 years old. Out of 33 patients, 27 (32.5%) were male and 6 patients were female (27.3%). Chronic anterior pituitary dysfunction also was seen in more patients with a severe traumatic head injury around 47.1%, a total of 23 patients sustained a severe head injury 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 months ± 1.79 and the median was 11 months. Chronic anterior pituitary commonly found in the patient enrolled in the study at 11 and 12 months post-trauma. All patient with pituitary dysfunction had positive CT brain findings. Out of 33 patients, 22 had SAH at the basal cistern and 27 patients had a base of skull fracture. 52.1% of the patient underwent surgical intervention and 8 patients didn’t undergo any surgical intervention. Out of all 33 patients with chronic anterior pituitary dysfunction, 84.8% involved 1 axis and another 5 (15.2%) patients had 2 axes involved. Binary logistic regression analysis studies the relationship between each of the variables and showed that severity of the head injury (p < 0.001), prolonged duration of hospital stay (p=0.014), radiological findings of a base of skull fracture(p <0.001), and presence of SAH at basal cistern (p<0.001) was significantly associated with chronic anterior pituitary dysfunction There was a significant difference seen in SF36 marks, where the patient with anterior pituitary dysfunction has the lower SF-36 marks 56.3± 10.3.Conclusion The prevalence of hypopituitarism was estimated at 31%. Indicators of increased TBI severity, prolonged hospitalization and positive finding of radiological assessment ( presence of SAH and base of skull fracture). Post traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF36 marks.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | chronic anterior pituitary dysfunction, traumatic brain injury |
| Subjects: | R Medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry |
| Divisions: | Kampus Kesihatan (Health Campus) > Pusat Pengajian Sains Perubatan (School of Medical Sciences) > Thesis |
| Depositing User: | MUHAMMAD AKIF AIMAN AB SHUKOR |
| Date Deposited: | 09 Apr 2026 04:50 |
| Last Modified: | 03 Jun 2026 07:38 |
| URI: | http://eprints.usm.my/id/eprint/63863 |
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