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Cited by 60Pituitary Gland Disorders and TreatmentsTraumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury Research

Pituitary dysfunction following traumatic brain injury: clinical perspectives

Open access
Tanriverdi, Fatih, Kelestimur, Fahrettin·2015·Neuropsychiatric Disease and Treatment
DOI 10.2147/ndt.s65814PMC PMC4524578
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Abstract

Traumatic brain injury (TBI) is a well recognized public health problem worldwide. TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies. Based on data in the current literature, approximately 15%-20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions. This review summarizes the current data on TBI-induced hypopituitarism and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review concludes that TBI-induced chronic hypopituitarism is common, affecting approximately 15%–20% of TBI patients, with growth hormone deficiency most frequent. It proposes screening all patients with complicated mild, moderate, or severe TBI, focusing acute-phase testing on ACTH deficiency and recommending long-term follow-up especially after complicated mild TBI.

Key findings

  • Approximately 15%–20% of TBI patients develop chronic hypopituitarism; a meta-analysis of 1,015 TBI patients found pooled anterior hypopituitarism prevalence of 27.5% (95% CI 22.8–28.9), with pooled rates of 16.8% in mild, 10.9% in moderate, and 35.3% in severe TBI.
  • A systematic review of 27 studies including 2,117 TBI patients reported long-term (>12 months) hypopituitarism in 31% (95% CI 23–40), defined as at least one anterior pituitary hormone deficiency.
  • In a retrospective screening study of 340 TBI patients, 28.5% had pituitary hormone dysfunction in at least one axis and 4.5% in two or more axes; gonadotropin (40.7%), ACTH (23.7%), and growth hormone (20.7%) deficiencies were most common.
  • Acute-phase ACTH deficiency frequency ranged from 4% to 78% across eleven studies; in one study of 100 consecutive TBI patients, 78 had at least one morning plasma cortisol <300 nmol/L during the first 10 days, and low cortisol was significantly associated with increased mortality and hyponatremia.

Methods

  • Narrative review summarizing current literature on TBI-induced hypopituitarism and discussing clinical perspectives on post-traumatic anterior pituitary hormone deficiency.
  • Synthesizes retrospective and prospective studies, meta-analyses, and systematic reviews, including specific cohorts such as 1,015 TBI patients, 2,117 TBI patients across 27 studies, and long-term prospective studies of 23, 30, and 25 patients.
  • Main analysis is a narrative synthesis of prevalence, screening strategies, and hormone deficiencies, leading to proposed inclusion/exclusion criteria and screening recommendations summarized in Figures 1 and 2.

Limitations

  • The paper states there are insufficient long-term prospective studies, small patient numbers in long-term studies (especially moderate and severe TBI groups), no epidemiological studies showing the population burden of disease, and unknown pathogenesis; it also states that screening recommendations after 12 months are not strong enough and need confirmation.
  • The paper notes that long-term prospective studies had insufficient numbers of patients with TSH and gonadotropin deficiencies to clarify the natural history of these axes.
  • Evident from the text: as a narrative review, no systematic search strategy, formal study-quality appraisal, or primary data collection is reported.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2147/ndt.s65814

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 143 cited sources checked · 4 supported · 3 flagged · accuracy not yet measured

  • Premisecitation

    Most patients in that study were discharged directly from the emergency service.

    “However, most of the patients in that study had mild TBI and do not need hospitalization and/or neurosurgical intervention, and most were discharged directly from the emergency service.25”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source

      The hospitalization table (Analytical procedures, p. 5) shows that 42 of 77 participants with mild TBI and all 30 participants with moderate-to-severe TBI were hospitalized: 72 of 107 participants overall. The Discussion (p. 9) says patients were eligible whether or not hospitalized, but does not say most were discharged from the emergency department. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    In one study, hypopituitarism was rare (<1% at a median 13 months after TBI) in unselected head trauma patients admitted to emergency departments.

    “In contrast, in one study, hypopituitarism was reported to be rare (<1% at a median 13 months after TBI) in unselected head trauma patients admitted to emergency departments, and it was concluded that routine pituitary screening in these patients is unlikely to be cost-effective.”
    • Also stated in: § Which patients should be screened? · plain
      “In contrast, it has been reported that hypopituitarism is rare in unselected patients with head trauma admitted to emergency departments.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source

      The Discussion (p. 9) reports pituitary dysfunction in fewer than 1% of the emergency-department-based TBI cohort, and the conclusion (p. 10) says routine screening of unselected patients is unlikely to be cost-effective. The timing is misstated: the study summary table (p. 8) gives a median follow-up of 14 months for the present study; the 13-month median in Patient characteristics (p. 6) refers to participating patients with mild TBI. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    In the study of unselected head trauma patients, most patients had mild TBI (n=77, 72%).

    “Most of the patients in this study had mild TBI (n=77, 72%).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source
  • Premisecitation

    Most pituitary hormonal changes (particularly FSH/LH, growth hormone, and TSH deficiencies) are transient and recover within 3-12 months of injury.

    “Prospective studies evaluating pituitary function have demonstrated that most pituitary hormonal changes (particularly FSH/LH, growth hormone, and thyroid-stimulating hormone [TSH] deficiencies) are transient and recover within 3–12 months of injury.16,26,43–45”
    Quote in the paperSubstantial claim1 of 5 sources checked
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source
    • cites [43] Agha A Phillips J O’Kelly P Tormey W Thompson CJ The natural history of post-traumatic hypopituitarism: implications for assessment and treatment Am J Med 2005 118 12 1416 16378796 source

      The Discussion reports that recovery occurred by 6 months in the majority of patients, particularly for gonadotropin deficiency; the Somatotropic axis section reports that 6 of 9 patients with acute growth hormone deficiency recovered by 12 months. The TSH claim is less well supported: Table 2 (p. 1416.e6) shows only one acute TSH deficiency, which resolved, while a new deficiency detected at 6 months persisted at 12 months. The paper therefore supports substantial recovery, but not a broad characterization of TSH deficiencies as particularly transient. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source
  • Premisecitation

    Six major prospective studies (five including patients with mild, moderate, or severe TBI) investigating pituitary function during the acute phase and 12 months later have been published.

    “So far, six major prospective studies (five including patients with mild, moderate, or severe TBI) investigating pituitary function during the and 12 months later have been published.9,15,16,43–45”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [43] Agha A Phillips J O’Kelly P Tormey W Thompson CJ The natural history of post-traumatic hypopituitarism: implications for assessment and treatment Am J Med 2005 118 12 1416 16378796 source
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 2
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    Among mild TBI patients in that study, 53% did not have loss of consciousness and 90% had post-traumatic amnesia of less than 30 minutes.

    “Among the mild TBI patients, 53% did not have loss of consciousness and 90% had post-traumatic amnesia of less than 30 minutes.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source

      The participant table (Analytical procedures, p. 5) reports loss of consciousness in 44 of 77 mild TBI patients (57%), so 43%—not 53%—did not lose consciousness. It reports 39% with post-traumatic amnesia lasting 1–30 minutes and 49% with no amnesia; combining those groups gives 88% with no amnesia or amnesia of up to 30 minutes, not 90% who had amnesia lasting less than 30 minutes. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    At 12 months after TBI, substantial rates of pituitary hormone deficiencies remain, ranging from 13% to 50%, with growth hormone deficiency the most common hormonal deficit.

    “At the end of 12 months, there were still substantial rates of pituitary hormone deficiencies, ranging from 13% to 50%, of which growth hormone deficiency was the most common hormonal deficit.”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [43] Agha A Phillips J O’Kelly P Tormey W Thompson CJ The natural history of post-traumatic hypopituitarism: implications for assessment and treatment Am J Med 2005 118 12 1416 16378796 source

      Table 2 (p. 1416.e6) shows that deficiencies persisted at 12 months, but not in the claimed pattern: ACTH deficiency affected 9 of 48 patients, gonadotropin deficiency 6, and growth hormone deficiency 5. Growth hormone deficiency was therefore not the most common, and this cohort's 12-month rates do not span 13%–50%. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source

  • May combine two claims.

    Premisecitation

    Most patients in that study had mild TBI and did not need hospitalization and/or neurosurgical intervention.

    “However, most of the patients in that study had mild TBI and do not need hospitalization and/or neurosurgical intervention, and most were discharged directly from the emergency service.25”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source

      Selection of patients (p. 3) reports that 77 of the 107 participants had mild TBI. The patient-characteristics table (p. 5) shows that only 4 underwent cranial surgery, but 72 were hospitalized; thus the claims that most did not need hospitalization and were discharged directly from the emergency department are not supported. (LLM, conf=0.93)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    TBI has previously been considered a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most retrospective and prospective studies.

    “TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies.”
    • Also stated in: § Introduction · plain
      “Although TBI has previously been considered as a rare cause of hypopituitarism, an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies.8–18”
    Quote in the paperSubstantial claim1 of 10 sources checked
    • cites [8] Agha A Rogers B Sherlock M Anterior pituitary dysfunction in survivors of traumatic brain injury J Clin Endocrinol Metab 2004 89 10 4929 4936 15472187 source

      The Discussion (page not provided) says undiagnosed pituitary dysfunction is common after TBI and that this study broadly agrees with earlier, smaller studies. It does not establish that TBI was previously considered a rare cause, or that most retrospective and prospective studies over the preceding 15 years reported increased prevalence. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [10] Benvenga S Campenni A Ruggeri RM Trimarchi F Clinical review 113: hypopituitarism secondary to head trauma J Clin Endocrinol Metab 2000 85 4 1353 1361 10770165 source
    • cites [11] Casanueva FF Leal A Koltowska-Haggstrom M Jonsson P Goth MI Traumatic brain injury as a relevant cause of growth hormone deficiency in adults: a KIMS-based study Arch Phys Med Rehabil 2005 86 3 463 468 15759229 source
    • cites [12] Kelly DF Gonzalo IT Cohan P Berman N Swerdloff R Wang C Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report J Neurosurg 2000 93 5 743 752 11059653 source
    • cites [13] Leal-Cerro A Flores JM Rincon M Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury Clin Endocrinol (Oxf) 2005 62 5 525 532 15853820 source
    • cites [14] Popovic V Pekic S Pavlovic D Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress J Endocrinol Invest 2004 27 11 1048 1054 15754737 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Premisecitation

    Prospective studies have demonstrated dynamic characteristics of hypopituitarism in isolated and multiple pituitary deficiencies and in improvement (recovery) or worsening (new-onset deficiencies) of pituitary function.

    “These prospective studies demonstrated the dynamic characteristics of hypopituitarism in isolated and multiple pituitary deficiencies as well as in the improvement (recovery) or worsening (new onset hormonal deficiencies) of pituitary function.”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [43] Agha A Phillips J O’Kelly P Tormey W Thompson CJ The natural history of post-traumatic hypopituitarism: implications for assessment and treatment Am J Med 2005 118 12 1416 16378796 source
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source

  • May combine two claims.

    Premisecitation

    Half of the patients with mild TBI were discharged directly from the emergency service without hospitalization; only 14% needed monitoring in intensive care and none had any neurosurgical intervention.

    “Half of the patients with mild TBI were discharged directly from the emergency service without hospitalization; only 14% of these mild TBI patients needed monitoring in intensive care and none had any neurosurgical intervention.25”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [25] van der Eerden AW Twickler MT Sweep FC Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury? Eur J Endocrinol 2010 162 1 19 28 19783620 source

      The patient-characteristics table (Analytical procedures, p. 5) reports that 55% of participating patients with mild TBI were hospitalized, so approximately half were not, and 14% received ICU care. It also reports cranial surgery in one mild-TBI participant, contrary to the claim that none had neurosurgical intervention. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Dynamic hormonal changes were defined mainly in the first 6 months but could be seen after 6 months.

    “The dynamic hormonal changes were defined mainly in the first 6 months but could be seen after 6 months.9,15,16,43–45”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [43] Agha A Phillips J O’Kelly P Tormey W Thompson CJ The natural history of post-traumatic hypopituitarism: implications for assessment and treatment Am J Med 2005 118 12 1416 16378796 source
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source

  • May combine two claims.

    Premisecitation

    In that study, gonadotropin (40.7%), ACTH (23.7%), and growth hormone (20.7%) deficiencies were the most common pituitary hormone disturbances.

    “Gonadotropin (40.7%), adrenocorticotropic hormone (ACTH; 23.7%), and growth hormone (20.7%) deficiencies were found to be the most common pituitary hormone disturbances.23”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Kopczak A Kilimann I von Rosen F Screening for hypopituitarism in 509 patients with traumatic brain injury or subarachnoid hemorrhage J Neurotrauma 2014 31 1 99 107 23980725 source

  • May combine two claims.

    Interpretationreasoning

    Pituitary dysfunction is not uncommon in patients with mild TBI and cannot be ignored.

    “Moreover, when we consider the high frequency of mild TBI among all TBI patients, it is obvious that pituitary dysfunction is not uncommon in patients with mild TBI and cannot be ignored.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In the study by Kleindienst et al, 23 patients with mild, moderate, or severe TBI were screened during the acute phase and at 24-36 months; in the chronic phase, 48% had ACTH deficiency and 39% had growth hormone deficiency.

    “In the study by Kleindienst et al, 23 patients with mild, moderate, or severe TBI were screened during the acute phase and at 24–36 months after their injury. In the chronic phase, 48% of the patients had ACTH deficiency and 39% had growth hormone deficiency.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source

  • May combine two claims.

    Premisecitation

    In that longest prospective study, significant rates of pituitary hormone deficiency remained at 5 years: 28% growth hormone, 4% ACTH, and 4% gonadotropin.

    “Although most of the pituitary hormone deficiencies improved over time, there were significant rates of pituitary hormone deficiency 5 years after TBI (28% growth hormone, 4% ACTH, and 4% gonadotropin).18”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Tanriverdi F De Bellis A Ulutabanca H A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma 2013 30 16 1426 1433 23470214 source

  • May combine two claims.

    Premisecitation

    There is an insufficient number of prospective studies in the literature, and there are still inadequate numbers of long-term prospective studies.

    “There is an insufficient number of prospective studies in the literature. Only three, long-term, prospective studies have evaluated pituitary function for longer than 12 months.17,18,26”
    • Also stated in: § Screening strategy during chronic phase of TBI · plain
      “Nevertheless, there are still inadequate numbers of long-term prospective studies in the literature.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source
    • cites [18] Tanriverdi F De Bellis A Ulutabanca H A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma 2013 30 16 1426 1433 23470214 source
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source

  • Classified as probably not a substantial claim.

    Premisecitation

    The severity of head trauma is a strong predictor of hypopituitarism.

    “This approach seems to be logical and practical because the severity of head trauma is a strong predictor.24”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Lauzier F Turgeon AF Boutin A Clinical outcomes, predictors, and prevalence of anterior pituitary disorders following traumatic brain injury: a systematic review Crit Care Med 2014 42 3 712 721 24247474 source

  • May combine two claims.

    Interpretationcitation

    Although the risk of developing hypopituitarism is highest in severe TBI, the risk is substantially high in mild TBI and comparable with moderate TBI.

    “These data clearly show that although the risk of developing hypopituitarism is highest in patients with severe TBI, the risk is substantially high in mild TBI even comparable with moderate TBI.”
    • Also stated in: § Which patients should be screened? · boosted
      “These data clearly show that although the risk of developing hypopituitarism is highest in severe TBI, the risk is substantially high in mild TBI and is even comparable with moderate TBI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a recent retrospective screening study of 340 TBI patients, 28.5% showed pituitary hormone dysfunction in at least one axis and 4.5% in two or more axes.

    “In a recent retrospective screening study that included 340 patients with TBI, 28.5% showed pituitary hormone dysfunction in at least one axis and 4.5% in two or more axes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Kopczak A Kilimann I von Rosen F Screening for hypopituitarism in 509 patients with traumatic brain injury or subarachnoid hemorrhage J Neurotrauma 2014 31 1 99 107 23980725 source

  • May combine two claims.

    Premisecitation

    The frequency of chronic hypopituitarism after TBI varies widely between studies, with most reporting a range of 15%-50%.

    “Although the frequency of chronic hypopituitarism (generally accepted as lasting at least 3 months) after TBI varies widely between the studies, most report a range of 15%–50%.9,15–17”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Interpretationreasoning

    TBI-induced hypopituitarism is frequent, in contrast with previous assumptions.

    “Based on data in the current literature, approximately 15%–20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions.”
    • Also stated in: § Frequency of TBI-induced chronic hypopituitarism · boosted
      “In summary, according to the current literature, approximately 15%–20% of TBI patients may develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is a frequent problem, in contrast with previous assumptions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Approximately 40% of mild TBI patients do not experience loss of consciousness.

    “It is documented that approximately 40% of mild TBI patients do not experience loss of consciousness.35”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Kraus JF Chu LD Epidemiology Silver JM McAllister TW Yudofsky SC Textbook of Traumatic Brain Injury Washington, DC, USA American Psychiatric Publishing Inc 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Low plasma cortisol has been reported to be significantly associated with increased mortality and existence of hyponatremia.

    “One of the most important findings of this study was the low plasma cortisol has been reported to be significantly associated with increased mortality and existence of hyponatremia.48”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Hannon MJ Crowley RK Behan LA Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality J Clin Endocrinol Metab 2013 98 8 3229 3237 23690314 source

  • May combine two claims.

    Premisecitation

    During the first 10 days after TBI, 78 of the 100 patients had at least one plasma cortisol measurement <300 nm/L, and most (63 of 78) had glucocorticoid deficiency on days 1, 2, and 3.

    “During the first 10 days after TBI, 78 of the 100 patients had at least one plasma cortisol measurement <300 nm/L, and most of the patients (63 of 78) had glucocorticoid deficiency on days 1, 2, and 3.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Hannon MJ Crowley RK Behan LA Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality J Clin Endocrinol Metab 2013 98 8 3229 3237 23690314 source

  • May combine two claims.

    Premisecitation

    Global screening of all mild TBI patients is not practical or cost-effective.

    “Although mild TBI is the most common type of head trauma, global screening of all mild TBI patients is not practical or cost-effective.33”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Tanriverdi F Unluhizarci K Kelestimur F Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy Pituitary 2010 13 2 146 153 20037793 source

  • May combine two claims.

    Premisecitation

    In one 3-year prospective follow-up study, 63% of patients had mild TBI and three of 18 (17%) mild TBI patients had pituitary dysfunction.

    “For example, in one 3-year, prospective, follow-up study, 63% of patients had mild TBI and three of 18 (17%) mild TBI patients had pituitary dysfunction.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Premisecitation

    All mild TBI patients included in that study needed hospitalization for more than 24 hours, and the majority were monitored in intensive care.

    “All mild TBI patients included in the study needed hospitalization for more than 24 hours, and the majority of these patients were monitored in intensive care.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Premisecitation

    To date, only eleven studies have evaluated pituitary function in the first 2 weeks after TBI, showing the frequency of ACTH deficiency to be between 4% and 78%.

    “To date, there have been only eleven studies evaluating pituitary function in the first 2 weeks after TBI (including mild, moderate, and severe TBI, and mainly screened in intensive care); these have showed the frequency of ACTH deficiency to be between 4% and 78%.16,26,42,44–46,48,50–53”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source
    • cites [42] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Pituitary functions in the acute phase of traumatic brain injury: are they related to severity of the injury or mortality? Brain Inj 2007 21 4 433 439 17487641 source
    • cites [44] Klose M Juul A Struck J Morgenthaler NG Kosteljanetz M Feldt-Rasmussen U Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study Clin Endocrinol (Oxf) 2007 67 4 598 606 17880406 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source
    • cites [46] Cohan P Wang C McArthur DL Acute secondary adrenal insufficiency after traumatic brain injury: a prospective study Crit Care Med 2005 33 10 2358 2366 16215393 source
    • cites [48] Hannon MJ Crowley RK Behan LA Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality J Clin Endocrinol Metab 2013 98 8 3229 3237 23690314 source
    • cites [50] Della CF Mancini A Valle D Provocative hypothalamopituitary axis tests in severe head injury: correlations with severity and prognosis Crit Care Med 1998 26 8 1419 1426 9710103 source
    • cites [51] Hackl JM Gottardis M Wieser C Endocrine abnormalities in severe traumatic brain injury – a cue to prognosis in severe craniocerebral trauma? Intensive Care Med 1991 17 1 25 29 2037721 source
    • cites [52] Agha A Rogers B Mylotte D Neuroendocrine dysfunction in the acute phase of traumatic brain injury Clin Endocrinol (Oxf) 2004 60 5 584 591 15104561 source

  • May combine two claims.

    Premisecitation

    In the Kleindienst et al study, by the chronic phase, 48% of patients had ACTH deficiency and 39% had growth hormone deficiency.

    “By the chronic phase, 48% of the patients had ACTH deficiency and 39% had growth hormone deficiency.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source

  • May combine two claims.

    Premisecitation

    In the Kleindienst et al study, 23 patients with mild, moderate, or severe TBI were screened during the acute phase and at 24-36 months after injury, and all patients with FSH/LH and TSH deficiencies recovered completely at the chronic phase.

    “In the study by Kleindienst et al, 23 patients with mild, moderate, or severe TBI were screened during the acute phase and at 24–36 months after injury. All the patients with FSH/LH and TSH deficiencies recovered completely at the chronic phase.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kleindienst A Brabant G Bock C Maser-Gluth C Buchfelder M Neuroendocrine function following traumatic brain injury and subsequent intensive care treatment: a prospective longitudinal evaluation J Neurotrauma 2009 26 9 1435 1446 19459759 source

  • May combine two claims.

    Premisecitation

    In the longest prospective study, ACTH and growth hormone deficiencies improved over time in a considerable number of patients with mild or moderate TBI, but in rare instances worsened over the 5-year period.

    “ACTH and growth hormone deficiencies improved over time in a considerable number of patients with mild or moderate TBI, but in rare instances worsened over the 5-year period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Tanriverdi F De Bellis A Ulutabanca H A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma 2013 30 16 1426 1433 23470214 source

  • May combine two claims.

    Premisecitation

    In the 3-year prospective study, no patient had TSH or gonadotropin deficiency after 3 years, compared with 6.6% and 3.3%, respectively, at 1 year.

    “No patient had TSH or gonadotropin deficiency after 3 years, compared with 6.6% and 3.3%, respectively, at 1 year.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Premisecitation

    In the 3-year prospective study, dynamic hormonal changes were reported mainly in patients with complicated mild TBI, while ACTH and growth hormone deficiencies persisted in patients with severe TBI at the 3-year evaluation.

    “It is important to note that dynamic hormonal changes were reported mainly in patients with complicated mild TBI, while ACTH and growth hormone deficiencies persisted in patients with severe TBI at the 3-year evaluation.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source

  • May combine two claims.

    Premisecitation

    Based on strong evidence from retrospective studies, the clinical behavior and neurological and neuroendocrine consequences of moderate TBI are similar to those of severe TBI, and moderate TBI is generally classified with severe TBI.

    “However, based on the strong evidence from retrospective studies, the clinical behavior and neurological and neuroendocrine consequences of moderate TBI are similar to those of severe TBI, and are generally classified with severe TBI.22,27,32”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [22] Schneider HJ Kreitschmann-Andermahr I Ghigo E Stalla GK Agha A Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review JAMA 2007 298 12 1429 1438 17895459 source
    • cites [27] Ghigo E Masel B Aimaretti G Consensus guidelines on screening for hypopituitarism following traumatic brain injury Brain Inj 2005 19 9 711 724 16195185 source
    • cites [32] Glynn N Agha A Which patient requires neuroendocrine assessment following traumatic brain injury, when and how? Clin Endocrinol (Oxf) 2013 78 1 17 20 22891644 source

  • May combine two claims.

    Premisecitation

    In four of the six prospective studies, new-onset pituitary hormone deficiencies were reported at the 12-month evaluation, at a lower frequency than recovery.

    “In all six studies, pituitary function recovered over a 12-month period, but in four9,15,16,45 new-onset pituitary hormone deficiencies (reported as lower frequency than recovery) were reported at the 12-month evaluation.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [9] Aimaretti G Ambrosio MR Di Somma C Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study J Clin Endocrinol Metab 2005 90 11 6085 6092 16144947 source
    • cites [15] Schneider HJ Schneider M Saller B Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury Eur J Endocrinol 2006 154 2 259 265 16452539 source
    • cites [16] Tanriverdi F Senyurek H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma J Clin Endocrinol Metab 2006 91 6 2105 2111 16522687 source
    • cites [45] Krahulik D Zapletalova J Frysak Z Vaverka M Dysfunction of hypothalamic-hypophysial axis after traumatic brain injury in adults J Neurosurg 2010 113 3 581 584 19929195 source

  • The quote only partly states this claim.

    Premisecitation

    In the longest prospective study, in patients with severe TBI, ACTH and growth hormone status at 1 year persisted at 5 years.

    “However, in patients with severe TBI, ACTH and growth hormone status at 1 year persisted at 5 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] Tanriverdi F De Bellis A Ulutabanca H A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism long-term after head trauma associated with autoimmunity? J Neurotrauma 2013 30 16 1426 1433 23470214 source

  • May combine two claims.

    Premisecitation

    In the 3-year prospective study, 30 patients were included; 63% had complicated mild TBI and the remaining had moderate or severe TBI.

    “Thirty patients were included in the 3-year prospective study, and 63% had complicated mild TBI and the remaining had moderate or severe TBI.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Tanriverdi F Ulutabanca H Unluhizarci K Selcuklu A Casanueva FF Kelestimur F Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study Clin Endocrinol (Oxf) 2008 68 4 573 579 17970777 source
33 of 33

  • The paper relies on this without support.

    Global screening of all TBI patients is not cost-effective.

    “However, this strategy is not cost-effective and would result in unnecessary consumption of health care resources in the community.”

  • The paper relies on this without support.

    Performing dynamic hormone tests (in particular for ACTH and growth hormone deficiencies) in the acute phase is either impractical or inappropriate.

    “Performing dynamic hormone tests (in particular for ACTH and growth hormone deficiencies) in the acute phase is either impractical or inappropriate.”

  • The paper relies on this without support.

    There are no clear or internationally accepted diagnostic cut-off values for diagnosis of hypopituitarism during the acute phase.

    “Moreover, there are no clear or internationally accepted diagnostic cut-off values for diagnosis of hypopituitarism during the acute phase.”

  • The paper relies on this without support.

    There are no epidemiological studies showing the burden of TBI-induced hypopituitarism in the population.

    “However, there are no epidemiological studies showing the burden of the disease in the population.”

  • The paper relies on this without support.

    Most patients with hypopituitarism are likely to remain undiagnosed and thereby untreated.

    “so most patients with hypopituitarism are likely to remain undiagnosed and thereby untreated.”

  • The paper relies on this without support.

    Clinical manifestations of hypopituitarism, especially isolated hormone deficiencies as in TBI, could be mild or subtle.

    “the clinical manifestations of hypopituitarism, especially isolated hormone deficiencies as in TBI, could be mild or subtle”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Even mild TBI confers an increased risk for chronic anterior pituitary hormone deficiencies, which may appear at a delay.

    “Even mild TBI confers an increased risk for chronic anterior pituitary hormone deficiencies, which may appear at a delay.”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [17]

    The Frequency of TBI-induced chronic hypopituitarism section reports anterior hypopituitarism after mild TBI, but specifies that the mild cases in the cited meta-analysis required hospitalization and neurosurgical intervention; it also reports a rate below 1% in a largely mild, unselected emergency-department population. The Screening strategy during chronic phase section describes possible new-onset deficiencies during follow-up after complicated mild TBI. The claim omits that qualification and extends the finding to mild TBI generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Deficiencies termed 'chronic' after 3 months do not always persist and may improve over time.

    “While deficiencies are often termed 'chronic' after 3 months, they do not always persist [17]. Deficiencies, even those diagnosed in the chronic post-TBI period, may improve over time [11, 18-21].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [17]

    The ‘Screening strategy during chronic phase of TBI’ section reports that some pituitary deficiencies resolved between years 1 and 3, supporting the statement attached to this citation that they do not always persist. It also says a 3-month assessment is too early for a definite diagnosis, but does not establish that deficiencies are often termed ‘chronic’ after 3 months. The later sentence about improvement has different citations. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Pituitary deficiencies are seen after mild TBI.

    “It is now clear that pituitary deficiencies are seen after mild TBI [17, 26 · ]”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [17]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Cortisol results are reported for an unlisted measurement day

    Minor

    The stated measurement schedule includes days 1 and 3 but not day 2, yet the results say patients had glucocorticoid deficiency on days 1, 2, and 3.

1 of 1

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Authors
Tanriverdi, F., & Kelestimur, F.
Venue
Neuropsychiatric Disease and Treatment
Publisher
Informa UK Limited
Published
2015-07
Volume
11
Pages
1835
ISSN
  • 1176-6328 (ISSN-L)
  • 1178-2021
DOI
10.2147/ndt.s65814
PMC
PMC4524578
OpenAlex
W1788223594
Semantic Scholar
b9d440d6d74505082c420e01ce74bd93392e1a74
Cited by
60
References
59
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 6 · 2019: 9 · 2018: 7 · 2017: 9 · 2016: 5
FWCI
5.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by-nc)
  • PubMed Central (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
traumatic brain injury, hypopituitarism, pituitary dysfunction, anterior pituitary insufficiency, neuroendocrine dysfunction, post-traumatic hypopituitarism

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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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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