Should every patient with traumatic brain injury be referred to an endocrinologist?

@article{Aimaretti2007ShouldEP,
  title={Should every patient with traumatic brain injury be referred to an endocrinologist?},
  author={Gianluca Aimaretti and Ezio Ghigo},
  journal={Nature Clinical Practice Endocrinology \&Metabolism},
  year={2007},
  volume={3},
  pages={318-319}
}
  • G. Aimaretti, E. Ghigo
  • Published 1 April 2007
  • Medicine, Biology
  • Nature Clinical Practice Endocrinology &Metabolism
Traumatic brain injury (TBI) can result in hypopituitarism, which in turn affects survival and reduces quality of life. Although this problem is recognized, TBI-related pituitary dysfunction remains underdiagnosed. There is currently no consensus about which patients should be screened; however, the authors of this Viewpoint suggest that case-finding might be the most effective approach. 
Pituitary dysfunction following traumatic brain injury: clinical perspectives
TLDR
Data in the current literature clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions, and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency.
Hypopituitarism following brain injury: when does it occur and how best to test?
TLDR
Both retrospective and prospective studies recommended that patients with more severe form of Brain Injuries and in particular, those with fractures of the base of the skull or early diabetes insipidus, have to be closely monitored for signs and symptoms of endocrine dysfunction.
The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance
TLDR
This article sets out guidance for the screening and management of pituitary dysfunction in adult patients with TBI, and it is hoped that future research will lead to more definitive recommendations in the form of guidelines.
Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy
TLDR
The frequency, characteristics and current management of pituitary dysfunction in patients with MTBI including the subjects exposed to sports related chronic mild head trauma are discussed.
Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury
TLDR
The purpose of this study was to evaluate the utility of targeted screening for hypopituitarism in long‐term survivors after moderate/severe TBI using referrals on the basis of symptoms.
Neuroendocrine surveillance and management of neurosurgical patients
TLDR
Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described and the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services.
Traumatic Injury to the Brain and Endocrine Evaluation of the Anterior Pituitary a Year After the Event (The TRIBE Study)
TLDR
The most common symptoms were weight gain & decreased vigor and signs of hypopituitarism were not noted among the mild TBI patients, while pituitary hormone testing revealed abnormalities in the somatotrophic & gonado-trophic axes.
Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach.
TLDR
The current data related to anterior pituitary dysfunction after TBI in adult patients are updated, and guidelines for the diagnosis, follow-up strategies, and therapeutic approaches are reported.
MANAGEMENT OF ENDOCRINE DISEASE: Neuroendocrine surveillance and management of neurosurgical patients.
TLDR
Endocrine sequelae of the acute brain insult and subsequent neurosurgery, peri-operative fluid administration and/or cranial irradiation are now well described and the surveillance and management of neuroendocrine dysfunction in neurosurgical patients poses significant logistic challenges to endocrine services.
The role of autoimmunity in pituitary dysfunction due to traumatic brain injury
TLDR
HPA seems to contribute to TBI-induced pituitary damage and related PTHP, and further prospective studies in a larger cohort of patients are needed to define etiopathogenic and diagnostic role of APA/AHA in development of post-traumatic hypothalamic/pituitary dysfunctions after a TBI.
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In order to gain further insight into hypopituitarism, that ensues moderate to severe traumatic brain injury (TBI), a group of experts actively working in the field gathered to exchange recent data
Consensus guidelines on screening for hypopituitarism following traumatic brain injury
TLDR
Participants at this unique consensus meeting attempted to define and spearhead an approach to increase awareness of the risks of TBI-induced endocrinopathies, in particular growth hormone deficiency (GHD), and to outline necessary and practical objectives for managing this condition.
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Traumatic Brain Injury and Hypopituitarism
TLDR
By increasing awareness among physicians of the risks of brain injuries–induced endocrinopathies and the need for appropriate endocrinological testing, it may be possible to improve the quality of life and enhance the rehabilitation prospects for patients with TBI-induced hypopituitarism.
Anterior pituitary dysfunction following traumatic brain injury (TBI)
TLDR
The potential contribution of PTHP to recovery and rehabilitation after injury and the need for the identification and the appropriate and timely management of hormone deficiencies to optimize patient recovery from head trauma, improve quality of life and avoid the long‐term adverse consequences of untreated hypopituitarism are discussed.
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TLDR
Pituitary hormone deficiencies were identified in a substantial proportion of patients with previous brain injury, and GH deficiency, found in 15% by glucagon stimulation testing, may compound the physical and psychological complications of traumatic brain injury and interfere with rehabilitation.
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TLDR
From this preliminary study, some degree of hypopituitarism appears to occur in approximately 40% of patients with moderate or severe head injury, with GH and gonadotroph deficiencies being most common.
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TLDR
There is high risk for H in TBI and SAH patients and early diagnosis of PH is always confirmed in the long term, whereas MH and IH were confirmed in 25% only.
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TLDR
The development of research guidelines to standardize definitional, case finding, and data reporting parameters to help establish a more precise description and hence utility of the epidemiology of TBI in Europe is highly recommended.