American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: A Neuroendocrine Approach to Patients With Traumatic Brain Injury
Abstract
Objective Traumatic brain injury (TBI) is now recognized as a major public health concern in the United States and is associated with substantial morbidity and mortality in both children and adults. Several lines of evidence indicate that TBI-induced hypopituitarism is not infrequent in TBI survivors and may contribute to the burden of illness in this population. The goal of this article is to review the published data and propose an approach for the neuroendocrine evaluation and management of these patients.Methods To identify pertinent articles, electronic literature searches were conducted using the following keywords: "traumatic brain injury," "pituitary," "hypopituitarism," "growth hormone deficiency," "hypogonadism," "hypoadrenalism," and "hypothyroidism." Relevant articles were identified and considered for inclusion in the present article.Results TBI-induced hypopituitarism appears to be more common in patients with severe TBI. However, patients with mild TBI or those with repeated, sports-, or blast-related TBI are also at risk for hypopituitarism. Deficiencies of growth hormone and gonadotropins appear to be most common and have been associated with increased morbidity in this population. A systematic approach is advised in order to establish the presence of pituitary hormone deficiencies and implement appropriate replacement therapies.Conclusion The presence of traumatic hypopituitarism should be considered during the acute phase as well as during the rehabilitation phase of patients with TBI. All patients with moderate to severe TBI require evaluation of pituitary function. In addition, symptomatic patients with mild TBI and impaired quality of life are at risk for hypopituitarism and should be offered neuroendocrine testing.
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Provocative testing, such as the cosyntropin stimulation test, is not reliable in the first 6 weeks after TBI.
“provocative testing (such as the cosyntropin stimulation test, the gold standard in the chronic period) is not reliable in the first 6 weeks after an injury”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [8]
Chronic pituitary dysfunction is reported in up to 42% of children and adolescents after TBI.
“and up to 42% of children and adolescents [6-9].”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [8]
Thyroxine has a long half-life.
“Due to the potential confounding effects of non-thyroidal illness (sick euthyroid syndrome) and the long half-life of thyroxine, it has been suggested that screening for hypothalamic–pituitary–thyroid dysfunction can reasonably be deferred for several (>4–6) weeks after TBI (assuming there is no suspicion of prior thyroid dysfunction).50 62”
From The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance (2017) · cites this paper as [62]
Diabetes insipidus (DI) following traumatic brain injury (TBI) is often transient.
“as DI is often transient.62”
From The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance (2017) · cites this paper as [62]
Non-thyroidal illness (sick euthyroid syndrome) can confound thyroid function tests after traumatic brain injury (TBI).
“Due to the potential confounding effects of non-thyroidal illness (sick euthyroid syndrome) and the long half-life of thyroxine, it has been suggested that screening for hypothalamic–pituitary–thyroid dysfunction can reasonably be deferred for several (>4–6) weeks after TBI (assuming there is no suspicion of prior thyroid dysfunction).50 62”
From The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance (2017) · cites this paper as [62]
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Neuroendocrine Disruptions Following Head Injury
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Self-citation
- Authors
- Tritos, N. A., Yuen, K. C. J., & Kelly, D. F.
- Affiliations
- Harvard University (US)
- Swedish Medical Center (US)
- Corresponding author
- Tritos, Nicholas A.
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 21
- Issue
- 7
- Pages
- 823-831
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W2195512504
- Cited by
- 51
- References
- 57
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 1 · 2020: 10 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 1 · 2015: 2
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Keywords
- traumatic brain injury, growth hormone deficiency, gonadotropin deficiency, hypogonadism, adrenal insufficiency, hypothyroidism, mild traumatic brain injury, sports-related brain injury
- MeSH terms
- Brain Injuries, Endocrinology, Humans, Hypopituitarism, Societies, Medical
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