Managing patients with hypopituitarism after traumatic brain injury

PURPOSE OF REVIEW: To highlight how traumatic brain injury as well as subarachnoid hemorrhage and primary brain tumors of the central nervous system can induce hypopituitarism - an underdiagnosed clinical problem. Then, further information of the problem is likely to stimulate appropriate screening programs for patients with brain injuries, at high risk of developing an unrecognized hypopituitarism. RECENT FINDINGS: Recent papers have alerted endocrinologists about brain injury-induced hypopituitarism. Both retrospective and prospective studies recommended that patients with more severe forms of head injury and, in particular, those with fractures of the base of the skull or early diabetes insipidus be closely monitored for signs and symptoms of endocrine dysfunction, and appropriate dynamic pituitary function tests performed. SUMMARY: We hope this review will stimulate further interest in the endocrine community about the pathophysiology and management (diagnosis and treatment) of different kinds and degrees of pituitary insufficiency due to traumatic brain injury. Further studies will be crucial to raise awareness and remind physicians of the prevalence of hypopituitarism in patients with traumatic brain injury, and elucidate any incremental benefits these patients may receive from hormone replacement.