Neuroendocrine consequences of traumatic brain injury and strategies for management

Abstract

Traumatic brain injury (TBI) is a common problem that generally affects the young population. Hypothalamo-pituitary damage may occur as a result of direct damage during trauma or due to secondary insults, such as hypotension or hypoxia that may occur thereafter. The incidence of pituitary dysfunction post-TBI has been reported to range from 5-76.4%. Growth hormone deficiency and central hypogonadism are among the most common hormone deficiencies that occur post-TBI. Patients who develop pituitary dysfunction post-TBI may present with life-threatening hypotension, hyponatremia during the acute phase, or subtle and nonspecific complaints such as fatigue, depression, or cognitive impairments during follow-up. Pituitary dysfunction may recover but new-onset deficiencies may develop over time, mandating routine screening of TBI patients. Several risk factors have been investigated and various screening algorithms have been proposed in recent studies. We aimed to review the recent literature in terms of epidemiology, screening modalities, and clinical perspectives of pituitary dysfunction post-TBI.