Traumatic brain injuries induced pituitary dysfunction: a call for algorithms

• Main Authors: Aleksandra Gilis-Januszewska, Łukasz Kluczyński, Alicja Hubalewska-Dydejczyk
• Format: Article
• Language: English
• Published: Bioscientifica 2020-05-01
• Series: Endocrine Connections
• Subjects: post-traumatic hypopituitarism; pituitary dysfunction; traumatic brain injury; pituitary insufficiency
• Online Access: https://ec.bioscientifica.com/view/journals/ec/9/5/EC-20-0117.xml

Traumatic brain injury affects many people each year, resulting in a serious burden of devastating health consequences. Motor-vehicle and work-related accidents, falls, assaults, as well as sport activities are the most common cause s of traumatic brain injuries. Consequently, they may lead to permanent or transient pituitary insufficiency that causes adverse changes in body composition, worrisome meta bolic function, reduced bone density, and a significant decrease in one’s quality of lif e. The prevalence of post-traumatic hypopituitarism is difficult to determine, and the exac t mechanisms lying behind it remain unclear. Several probable hypotheses have been sugges ted. The diagnosis of pituitary dysfunction is very challenging both due to the commo n occurrence of brain injuries, the subtle character of clinical manifestations, the variable course of the disease, as well as the lack of proper diagnostic algorithms. Insufficienc y of somatotropic axis is the most common abnormality, followed by presence of hypogonadi sm, hypothyroidism, hypocortisolism, and diabetes insipidus. The purpose of this re view is to summarize the current state of knowledge about post-traumatic hypopituita rism. Moreover, based on available data and on our own clinical experience, we sugges t an algorithm for the evaluation of post-traumatic hypopituitarism. In addition, well-designed studies are needed to further investigate the pathophysiology, epidemiology, and timing of pituitary dysfunction after a traumatic brain injury with the purpose of establishing appropriate standards of care.