Research Reports - Post-traumatic head injury pituitary dysfunction

Disabil Rehabil. 2012 Jul 10

Zaben M, El Ghoul W, Belli A

Partial or complete pituitary dysfunction affects 33-50% of all traumatic brain
injury (TBI) survivors and is a significant contributor to the overall disability
burden. The hypophyseal vessels are anatomically vulnerable to shearing injuries,
raised intracranial pressure and anterior base of skull fractures, and pituitary
ischaemia or haemorrhage is a common finding at autopsy. Post-traumatic
hypopituitarism (PTHP) can affect all grades of severity of injury and is often
difficult to diagnose, as its features largely overlap with common
post-concussive symptoms. PTHP has a wide range of manifestations, including
fatigue, myopathy, cognitive difficulties, depression, behavioural changes or
life-threatening complications such as sodium dysregulation and adrenal crisis.
In some instances, mild PTHP can recover, at least partially, but cases of late
onset are also known. At present, there is no consensus on whether all TBI
patients should be screened (including mild TBI) and at what time points, given
that neuroendocrine tests in the acute phase are simply likely to reflect a
non-specific trauma response rather than true pituitary damage and that the time
course of PTHP is unclear. A full investigation of the hypothalamic-pituitary
axis requires specialized neuroendocrine assessment, including stimulation tests,
as random hormone levels can be misleading in this context. Given the high
incidence of TBI, this may have significant resource implications for
Endocrinology services but, on the other hand, patients with PTHP may receive
suboptimal rehabilitation unless the underlying hormone deficiency is identified
and treated.

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