Endocrine Abstracts

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. While there is a large and growing body of literature on the risk of pituitary dysfunction after brain injury, differences in assays and definitions account in part for the broad range of reported prevalence, and highlight the importance of a rigorous review of the evidence. Given the large number of people with a history of TBI, there has been much investigation into features that may predict neuroendocrine dysfunction. Studies have investigated biomarkers, imaging characteristics, and types of injury, but no consistent clinically useful association has been described. Thus, we rely on signs and symptoms to determine whom to screen. The overlap in symptoms seen in pituitary deficiencies and following TBI, and the potential clinical benefit of identifying hypopituitarism, make it particularly important to be aware of patterns that suggest pituitary dysfunction. Symptoms from hypopituitarism include cognitive, physical, and emotional effects, and overlap with symptoms from other etiologies including TBI itself. Clinical symptoms may include difficulties with executive function, increased anxiety and irritability, irregular menses, sexual side effects, and fatigue, and delay physical and neurorehabilitation efforts. 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. In addition, there are indications that the cognitive issues and fatigue that may be seen as part of “Long Hauler” syndrome after COVID-19/SARS-CoV- infection may be related to pituitary deficiencies. This presentation 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; emerging information regarding other forms of brain injury will be included, and specific populations (military, children, women) will be highlighted.