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Prevalence of Neuroendocrine Dysfunction in Patients Recovering from Traumatic Brain Injury
Abstract
Although hypopituitarism is a known complication of head injury, it may be underrecognized due to its subtle clinical manifestations. The nonspecific symptoms may be masked by and may contribute to the physical and psychological sequelae of brain trauma. This study examines the prevalence of neuroendocrine abnormalities in patients rehabilitating from traumatic brain injury. Seventy adults (mean age, 31.5 +/- 1.1 yr; range, 18--58; 46 men and 24 women) with traumatic brain injury an average of 49 +/- 8 months before the study (median, 13 months) underwent a series of standard endocrine tests, including serum levels of TSH, free T(4), insulin-like growth factor I, PRL, testosterone (males), and cosyntropin stimulation. Abnormal results of these tests were followed by dynamic tests of gonadotropin, TSH, and GH secretion. Glucagon stimulation testing in 48 subjects revealed GH deficiency (peak, <3 microg/L) in 14.6%. Free T(4) (n = 6; 8.6%), TSH (n = 7; 10%), or both (n = 2; 2.9%) were low in 21.7%, whereas 87% had both TSH and free T(4) below the midnormal level. Basal morning cortisol was below normal in 45.7% of subjects, whereas cosyntropin-stimulated levels were insufficient (peak, <500 nmol/L) in 7.1%. Hypogonadism and hyperprolactinemia were uncommon. In summary, pituitary hormone deficiencies were identified in a substantial proportion of patients with previous brain injury. GH deficiency, found in 15% by glucagon stimulation testing, may compound the physical and psychological complications of traumatic brain injury and interfere with rehabilitation.
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In the citing paper
“In 2000 and 2001, Kelly et al. and Lieberman et al. found a high prevalence of anterior pituitary dysfunction in patients with a previous history of moderate and severe TBI[13,14].”
From Traumatic Brain Injury and Hypopituitarism (2005) · cites this paper as [14]
In the citing paper
“In addition, two preliminary studies reported a high prevalence of hypopituitarism after TBI (13,18).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [13]
In the citing paper
“Our data contrast with the results of Lieberman et al. (8), who reported that 45.7% of TBI patients tested had a morning cortisol of less than 7 g/dl (193 nmol/liter), although only 7.1% failed the SST.”
From Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury (2004) · cites this paper as [8]
In the citing paper
“followed by hypogonadism with rates averaging 14%”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [41]
In the citing paper
“New chronic somatotroph failure (growth hormone deficiency) averages 15–18% of patients”
From Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury (2012) · cites this paper as [41]
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Flerlage, W. J., Simmons, S. C., Thomas, E. H., Gouty, S., Tsuda, M. C., Wu, T. J., Armstrong, R. C., Cox, B. M., & Nugent, F. S. (2024) · Journal of Neurotrauma · doi:10.1089/neu.2024.0184 · Cited by 5
Epidemiology and risk factors for hypopituitarism due to traumatic brain injury
Ünlühızarcı, K., & Urhan, E. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.101997 · Cited by 6
Metadata
- Authors
- Lieberman, S. A.
- Corresponding author
- Lieberman, S. A.
- Venue
- Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2001-06-01
- Volume
- 86
- Issue
- 6
- Pages
- 2752-2756
- ISSN
- 0021-972X (ISSN-L)
- OpenAlex
- W4246438689
- Cited by
- 261
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 5 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 12 · 2017: 11 · 2016: 7 · 2015: 14 · 2014: 10 · 2013: 11 · 2012: 18
- FWCI
- 3.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- neuroendocrine dysfunction, traumatic brain injury, recovery, prevalence, hypothalamic-pituitary-adrenal axis, endocrine disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
