Acute neuroendocrine changes after traumatic brain injury

Area of Science:

• Neuroendocrinology
• Trauma Surgery
• Internal Medicine

Background:

• Post-traumatic hypopituitarism (PTHP) is an underrecognized complication following traumatic brain injury (TBI).
• Endocrine dysfunction can significantly influence patient recovery and long-term health after TBI.

Purpose of the Study:

• To comprehensively review the epidemiology, pathophysiology, clinical features, and diagnostic strategies for PTHP.
• To synthesize current evidence on the prevalence and impact of various hormone deficiencies post-TBI.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, Cochrane Library, and Web of Science.
• Inclusion of 45 human studies examining acute endocrine changes after mild, moderate, and severe TBI.

Main Results:

• Traumatic brain injury (TBI) severity is a key risk factor for PTHP.
• Adrenal insufficiency (AI) affects up to 50% of severe TBI patients. Thyroid axis suppression (2-33%) and somatotrophic axis dysfunction (9-36%) are linked to adverse neurological outcomes.
• Arginine-Vasopressin (AVP) deficiency (15-51%) is associated with increased mortality; hyperprolactinemia is common but often clinically insignificant.

Conclusions:

• PTHP is prevalent after TBI, impacting various endocrine axes and patient outcomes.
• Further research is crucial to identify at-risk patients, optimize endocrine testing timing, and refine diagnostic and treatment protocols.
• Improved management of PTHP is essential for enhancing neurological recovery and overall patient prognosis.