Improving Awareness of Hypopituitarism in Traumatic Brain Injury

While affected war veterans have galvanized our search to understand traumatic brain injury (TBI), the 1.7 million individuals who incur sports-related and accidental central nervous system insults from other causes are also of concern.

Though anterior hypopituitarism is a special concern in those patients, the condition remains under-diagnosed. And while the risk of hypopituitarism is greatest in patients with severe TBI, patients with mild TBI are also at significant risk. In fact, it’s currently estimated that approximately 27.5% of those who experience TBI also suffer from hypopituitarism as a consequence of mechanical and/or ischemic injury.

In a review published in Endocrinology and Metabolism Clinics of North America, researchers from Mount Sinai Medical Center explored hypopituitarism in great detail. According to the authors, neuropsychiatric complaints and the signs and symptoms of hypopituitarism often overlap, as memory deficits, poor concentration, lack of good judgment, impaired problem solving, fatigue, anxiety, depression, and social isolation are all common to both conditions.

Nevertheless, predicting which patients will develop hypopituitarism is impossible. Therefore, improving awareness of hypopituitarism in TBI patients is vital. Though deficiencies of the growth hormones somatotropin and gonadotropin are more common than a lack of thyrotropin and corticotrophin, growth hormone deficits in general seem to bring on the most significant clinical symptoms, especially in TBI patients who haven’t achieved peak bone mass.

The authors advised clinicians to evaluate patients routinely for all hormonal deficiencies at 3 to 6 months after initial trauma, as well as document a detailed history and physical examination. In addition, the researchers recommended pituitary testing when symptoms of hypopituitarism are visible.

While many patients’ pituitary function recovers, the recovery is sometimes fleeting. At 1 year, hormone replacement should address specific pituitary deficits, though it may turn out to be a chronic need.

As clinicians become more aware of posttraumatic hypopituitarism, their collective knowledge should improve management approaches.