Neuroendocrine Dysfunction After TBI

Post-traumatic hypopituitarism (PTHP) is known to occur after many cases of traumatic brain injury (TBI), and it may contribute to cognitive and emotional sequelae that affect patient quality of life, morbidity, and mortality. Common types of endocrine dysfunction in the acute phase after TBI include secondary adrenal insufficiency, central diabetes insipidus, and the syndrome of inappropriate antidiuretic hormone secretion. In the chronic phase, the most common forms of TBI-related hormonal disorders are growth hormone deficiency, chronic secondary adrenal insufficiency, secondary hypogonadism, and secondary hypothyroidism. These endocrinopathies may contribute to such sequelae as fatigue, cognitive impairment, emotional dysregulation, and sexual dysfunction. The impact on special populations, such as pediatric and female patients, and their altered experiences of puberty and fertility are also discussed. Furthermore, the mechanisms underlying PTHP are explored, including direct injury during TBI or secondary injury via edema, ischemia, or autoimmunity. Given the impact of PTHP on patient quality of life, certain patient populations at risk should be screened for early identification and management of potential underlying endocrine disorders.