Background  Several studies have reported a high prevalence of hypopituitarism after traumatic brain injury (TBI). Risk stratification is a prerequisite for cost-effective hormonal screening of these patients. However, it is still unclear which risk factors predispose patients to develop anterior hypopituitarism after TBI.

Objective  To assess clinical and radiological risk factors for post-traumatic hypopituitarism.

Patients and methods  Seventy-eight consecutive patients (52 men, 26 women; mean age 36·0 years, range 18–65 years) with mild, moderate or severe TBI were studied. Endocrine and clinical parameters were assessed 3 and 12 months after TBI.

Results  We found diffuse axonal injury, basal skull fracture and older age to be major risk factors of post-traumatic hypopituitarism.

Conclusions  We have defined specific risk factors for the development of post-traumatic hypopituitarism that are consistent with pathophysiological considerations. These findings might help to identify at-risk patients.