AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: A NEUROENDOCRINE APPROACH TO PATIENTS WITH TRAUMATIC BRAIN INJURY.

Review article
Tritos NA, et al. Endocr Pract. 2015.
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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.

PMID 26172127 [PubMed – indexed for MEDLINE]
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Comment in
Endocr Pract. 2015 Jul;21(7):851-3.
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Author: tbihealing

Sean Dudas is a California native and remains active and interested in many corners of life. In November of 2015, Sean suffered a moderate traumatic brain injury from a fall; his life since has been solely devoted to the topic of this blog - TBI and other forms of acquired brain injury. With his passions and life as he imagined it to be on an indeterminate hold during his rehabilitation and recovery, he began this blog and a TBI health advocacy group. Through uniform rules of professional responsibility and ethics, he hopes the health advocate profession may be an affordable adjunct to the team needed by every brain injured person and those caring for them. He hopes that this blog will continue educating and supporting survivors of brain injury, their caregivers, and anyone interested in this devastating medical sojourn, alongside the discovery of a new self and a meaningful life outside the treatment environment. Sean is active in supporting mental health and suicide crisis support, various manifestations of trauma in children and adults, and is a Doctor of Law with a focus on health and science law. He is also an athlete, poet, writer, and nature enthusiast.

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