Posttraumatic Hypopituitarism: Neuroendocrine Dysfunction and Treatment

Posttraumatic hypopituitarism (PTH) can occur following various modes of acquired brain injury at all levels of severity (i.e., mild, moderate, and severe). Chronic dysfunction of the pituitary axis is observed in approximately one-third of individuals who experience a moderate-to-severe traumatic brain injury (TBI). Many of the sequelae associated with TBI have typically been attributed to cortical and subcortical damage. However, analyses of the signs and symptoms of pituitary axis dysfunction suggest that in a significant proportion of patients with TBI, the observed cognitive, psychiatric, and physical/functioning impairments may actually be the result of abnormal growth hormone secretion and could potentially be reversed with growth hormone replacement therapy. Early diagnosis of PTH and subsequent treatment can improve outcomes; however, PTH typically is not identified or treated due to masking effects of impairments secondary to damage to brain parenchyma other than the pituitary.