Prevalence, natural history and consequences of posttraumatic hypopituitarism: a case for endocrine surveillance

The phenomenon of posttraumatic hypopituitarism (PTHP) has been recognised for more than 90 years although it is only in the last decade that systematic study of large populations of patients has been undertaken. Knowledge of the prevalence and natural history of the condition in survivors of traumatic brain injury (TBI) in adult life is expanding rapidly, although the effect of hormone replacement therapy is largely unknown. Data relating to injury in childhood are less readily available. The symptoms of PTHP and TBI may be indistinguishable in the adult patient and biochemical assessment of pituitary function is required for diagnosis. These procedures are costly for both the health provider and the patient. So can routine assessment of pituitary function be justified? This review article considers the current state of knowledge pertaining to prevalence, natural history and clinical consequences of PTHP to address this question.