Research progress on hypopituitorism after traumatic brain injury

Abstract

Hypopituitorism is a common complication of traumatic brain injury (TBI) , which can happen both at acute and chronic stages after TBI. There are different clinical features of hypopituitorism happened at acute and chronic stages. At acute stage, dysfunction of pituitary-adrenal cortical axis is of the most clinical significance, which can cause hypotension, hypoglycemia, hyponatremia and lead to life-threatening complications. Growth hormone deficiency and hypogonadotropic hypogonadism are the two most common endocrine deficits at chronic stage. Symptoms of hypopituitorism at chronic stage include fatigue, cognitive impairment, decreased exercise capacity, decreased libido and so on. Assessment of pituitary function should be carried out for patients with moderate to severe TBI during the acute phase, focusing on the function of pituitary-adrenal axis. If patients manifest symptoms related to hypopituitorism during chronic stage, comprehensive evaluation of pituitary function should be carried out. The diagnosis of hypopituitorism should be based on basic hormone level and corresponding stimulation test. Hypofunction of pituitary-adrenal cortical axis in the acute phase of TBI should be treated with glucocorticoid immediately because of its potential contribution to the acute morbidity and mortality. Severe hypofunction of pituitary-thyroid axis should also be treated with thyroxine replacement. Most growth hormone deficiency and hypofunction of pituitary-gonadal axis occurred in the acute phase could be improved by themselves with time migration, so there is no need to be treated in this phase. Hypopituitorism occurred in the chronic phase of TBI may have lasting effect on cognition and life quality. Hormone replacement should be carried out once the diagnosis is confirmed. \n \n \nKey words: \nTraumatic brain injury;\xa0Hypopituitorism;\xa0Hypocortisolism;\xa0Hormone replacement