Approach to the patient with traumatic brain injury (TBI)-induced pituitary dysfunction

Abstract

Traumatic brain injury (TBI), a growing public health concern worldwide, has recently been recognized as one of the most common etiologies of hypopituitarism. Leading causes of TBI-induced pituitary dysfunction include road traffic accidents, falls, domestic violence, sport-related injuries and war injuries. The prevalence of hypopituitarism after TBI is about 15% and growth hormone is the most common pituitary hormone deficiency after TBI. Because the clinical spectrum of TBI-induced pituitary dysfunction is broad and most of the manifestations are nonspecific, the diagnosis is often delayed and many patients remain undiagnosed and untreated. Current evidence show that pituitary hormone deficiencies seen in patients with mild and moderate TBI may improve over time in a considerable number of patients, but some may also worsen over time. Since not all TBI patients develop pituitary dysfunction, testing all patients with a history of TBI is not realistic and cost-effective. Predictive factors of post-TBI hypopituitarism including number of hormone deficiencies during acute phase, radiological abnormalities, genetic polymorphism, older age, female gender should be taken into account for development of screening strategies. Prospective screening of pituitary functions is required in complicated mild TBI (defined as clinically mild by all severity measures but considered complicated due to a traumatic intracranial abnormality visible on neuroimaging), moderate and severe TBI patients. Increased awareness of TBI-induced hypopituitarism in the medical community may lead to earlier diagnosis and prompt treatment of hypopituitarism with appropriate replacement of deficient hormones.

Keywords: Traumatic brain injury; growth hormone deficiency; hypopituitarism; pituitary; sports-related head trauma.