Pituitary function after traumatic brain injury

Results of recent and ongoing studies have made it clear that TBI poses substantial risk to pituitary function, perhaps even greater than previously believed. It is essential that patients with TBI be screened both prospectively and retrospectively for isolated and multiple pituitary deficits. Furthermore, it is well known that patients with “classical“ hypopituitarism do benefit from hormonal replacement therapy. Patients with TBI-induced hypopituitarism should initially receive critical replacement therapy such as anti-diuretic hormone (ADH), glucocorticoid and thyroid hormones. Gonadal and rhGH replacement therapy should also be introduced if there are deficiencies demonstrated and reconfirmed in a second step. The signs and symptoms of post-traumatic hypopituitarism may be masked by what has been assumed to be merely the clinical sequelae of a TBI. It has been suggested that patients with hypopituitarism following a TBI may benefit with appropriate hormonal replacement. By increasing awareness among physicians of the risks of TBI-induced endocrinopathy and the need for appropriate endocrinological testing, it may be possible to improve the quality of life and enhance the rehabilitation prospects for these patients. In most instances, these patients are first seen and treated by trauma surgeons and neurosurgeons, and subsequently by rehabilitation physicians; they must be knowledgeable about the risks of hypopituitarism so that they can determine which patients are candidates for screening for hypopituitarism. In addition, endocrinologists and internists must be educated about TBI-induced hypopituitarism and encouraged to actively share their expertise with other physicians. Conclusions: Prospects for rehabilitation of patients with TBI-induced hypopituitarism may be enhanced by appropriate neuroendocrine diagnostic approach leading to proper hormonal replacement therapies. Further exploration of this possibility requires an active collaboration between divisions of endocrinology and rehabilitation doctor at the local level to perform a screening of pituitary function in patients following TBI.