Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2014) 34 S5.2 | DOI: 10.1530/endoabs.34.S5.2

SFEBES2014 Symposia Endocrine consequences of major trauma (3 abstracts)

Pituitary sequelae of traumatic brain injury

Chris Thompson


Beaumont, Dublin, Ireland.


Traumatic brain injury is well recognised to cause pituitary dysfunction. Although data suggests that this is uncommon after mild head injury (GCS 14–15), the consensus from a large number of papers, using different assays and methods of testing, is that 15–30% of long term survivors of TBI have pituitary dysfunction. This offers the option of medical therapy after TBI, to improve quality of life and, potentially, improve rehabilitation.

In the acute phase of TBI, it is clear that vascular insult to the pituitary can cause acute anterior hypopituitarism, in addition to hyponatreamia due to SIADH and diabetes insipidus. Recent evidence from our own group has shown that as many as 78% of patients will have inappropriately low plasma cortisol concentrations for a sick patient. Approximately 10% of post TBI ‘SIADH’ is also attributable to cortisol deficiency. Diabetes insipidus is a predictor of early mortality after TBI.

Most acute hormonal changes improve spontaneously, but some persist to become chronic deficiencies. In addition, some patients with normal pituitary function can show deterioration to hypopituitarism over the 3–6 months after TBI. Changes are less dynamic thereafter, with most deficiencies permanent.

Chronic hypopituitarism varies from isolated pituitary hormone deficits to severe panhypopituitarism; most diabetes insipidus and nearly all SIADH recovers completely.

The challenge for screening is to identify the patients most likely to benefit from screening, given the logistics of patient numbers. Currently there is little consensus on the accuracy of predictors of long-term hypopituitarism, which can be utilised to form the basis of a functioning screening programme for post-TBI hypopituitarism.

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