Screening for Hypopituitarism Following Traumatic Brain Injury (TBI)

Abstract

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