Pathophysiology and diagnosis of neuroendocrine abnormalities in patients with traumatic brain injury

One of the possible clinical complications following traumatic brain injury (TBI) is post-traumatic hypopituitarism. Severe TBI can disrupt the hypothalamus-pituitary-peripheral hormone axes, not only in the acute phase but also over the long term, potentially resulting in persistent pituitary dysfunction. Acute critical illness and its management can alter the normal adaptive response of the hypothalamus-pituitary axis through changes in metabolism, hormone binding, and hormone production. In the context of TBI, structural brain damage may further impair hypothalamus-pituitary function by directly disrupting its anatomical integrity. Diagnosing pituitary hormone imbalances in the acute phase after TBI is challenging, and the clinical significance remains debatable. However, adrenal insufficiency and ADH deficiency poses a life-threatening risk if left untreated and requires prompt intervention. Practical points are provided on how to recognize, avoid, and manage both over- and underdiagnosis of hypopituitarism in patients with TBI.