Navigating anterior pituitary dysfunction after traumatic brain injury: mechanisms, diagnosis, and management

Post-traumatic hypopituitarism (PTHP), a condition primarily affecting the anterior pituitary, represents a significant and frequently underdiagnosed consequence of traumatic brain injury (TBI). Its clinical course is dynamic, with deficiencies that can be transient, persistent, or of late onset, profoundly impacting both acute prognosis and long-term cognitive and functional recovery. This review summarizes the complex pathophysiology of PTHP, covering established mechanisms such as mechanical and vascular insults, while also discussing emerging concepts including NLRP3 inflammasome-driven pyroptosis, cellular senescence, and the potential role of pituitary-resident folliculostatellate (FS) cells in the secondary injury cascade. From a clinical perspective, the review emphasizes a longitudinal approach to diagnosis and management that spans the acute to chronic phases, addressing key diagnostic pitfalls and summarizing evidence-based therapeutic strategies. By synthesizing current pathophysiological concepts and clinical practices, this review aims to enhance clinical awareness, bridge the knowledge-translation gap, and provide a resource to help optimize care for this vulnerable patient population.