[Hormonal diseases after traumatic brain injury]

Area of Science:

• Neuroendocrinology
• Trauma Surgery

Context:

• Traumatic brain injury (TBI) is a significant global health concern.
• Posterior pituitary dysfunction, including diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH), is common in the acute phase post-TBI.
• While often transient, persistent DI affects 5-7% of TBI patients.

Purpose:

• To outline the essential diagnostic investigations for identifying hypopituitarism in TBI survivors.
• To highlight the prevalence and types of pituitary hormone deficiencies following moderate to severe TBI.
• To inform clinical practice regarding the timely diagnosis and potential benefits of substitution therapy for TBI-induced hypopituitarism.

Summary:

• Permanent hypopituitarism affects 25-50% of patients after moderate to severe TBI.
• Growth hormone (17.6%) and gonadotropin (13.4%) deficiencies are most prevalent, followed by corticotropin (8.4%) and thyrotropin (4.3%) deficiencies.
• Combined pituitary hormone deficiencies occur in 9% of TBI patients, necessitating comprehensive assessment.

Impact:

• Establishes minimum investigation protocols for diagnosing TBI-related hypopituitarism.
• Emphasizes the long-term endocrine consequences of TBI, often overlooked.
• Guides clinicians in identifying TBI patients who would benefit from hormone replacement therapy, improving patient outcomes.