Tamara L. Wexler, MD, PhD

Session Summary

While increasing attention is being paid to the health effects of brain injury, the role that neuroendocrine dysfunction may play in patients’ health after traumatic brain injury (TBI) remains underappreciated. Pituitary deficiencies are seen at a high rate in patients who have sustained TBI, with reports of chronic pituitary dysfunction in 15-60% of adults after TBI, and up to 42% of children and adolescents. Deficiencies may resolve over time, or develop years after injury, and may occur after mild or severe injury.

Pituitary deficiencies may include potentially fatal adrenal insufficiency, as well as reproductive hormone abnormalities, growth hormone deficiency, and centrally mediated thyroid deficiency. Hypopituitarism impacts health and quality of life, and, untreated, is associated with increased mortality as well as morbidity.

Hypopitituitarism may have cognitive, physical, and emotional effects, and may delay physical and neurorehabilitation efforts. Symptoms overlap with those from other etiologies including TBI itself, and may include difficulties with executive function, increased anxiety and irritability, irregular menses, sexual side effects, and fatigue. It is particularly important to be aware of patterns that suggest pituitary dysfunction in patients with persistent symptoms after TBI, as replacement of deficient hormones can ameliorate or reverse the effects of hypopituitarism.

This seminar will review the current understanding of pituitary dysfunction following TBI and the clinical relevance of pituitary axes and offer a practical approach to evaluation and treatment.