Neuroendocrine Dysfunction after TBI: Evaluation and Management from a Multidisciplinary Perspective

Pituitary deficiencies are seen at a high rate in patients who have sustained TBI. Deficiencies may resolve over time, or develop years later, and may occur after mild or severe injury. Pituitary deficiencies may include adrenal insufficiency, reproductive hormone abnormalities, growth hormone deficiency, and central hypothyroidism. Hypopituitarism impacts health and quality of life, and, untreated, is associated with increased mortality as well as morbidity. Symptoms from hypopituitarism include cognitive, physical, and emotional effects, and overlap with symptoms from other etiologies. It is essential to be aware of patterns that suggest pituitary dysfunction in patients with persistent symptoms after TBI, as replacement of deficient hormones can reverse the effects of hypopituitarism. This seminar will review the current understanding of pituitary dysfunction following TBI and the clinical relevance of pituitary axes, offering a practical approach to evaluation and treatment. This issue is germane to many specialties, and a multidisciplinary panel will present.