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Impaired Pituitary Axes Following Traumatic Brain Injury
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Hypopituitarism in Traumatic Brain Injury—A Critical Note

Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Denmark
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Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editors: Günter Stalla and Anna Kopczak
J. Clin. Med. 2015, 4(7), 1480-1497; https://doi.org/10.3390/jcm4071480
Received: 29 April 2015 / Revised: 25 June 2015 / Accepted: 30 June 2015 / Published: 14 July 2015
(This article belongs to the Special Issue Neuroendocrine Disturbances after Brain Damage)
While hypopituitarism after traumatic brain injury (TBI) was previously considered rare, it is now thought to be a major cause of treatable morbidity among TBI survivors. Consequently, recommendations for assessment of pituitary function and replacement in TBI were recently introduced. Given the high incidence of TBI with more than 100 pr. 100,000 inhabitants, TBI would be by far the most common cause of hypopituitarism if the recently reported prevalence rates hold true. The disproportion between this proposed incidence and the occasional cases of post-TBI hypopituitarism in clinical practice justifies reflection as to whether hypopituitarism has been unrecognized in TBI patients or whether diagnostic testing designed for high risk populations such as patients with obvious pituitary pathology has overestimated the true risk and thereby the disease burden of hypopituitarism in TBI. The findings on mainly isolated deficiencies in TBI patients, and particularly isolated growth hormone (GH) deficiency, raise the question of the potential impact of methodological confounding, determined by variable test-retest reproducibility, appropriateness of cut-off values, importance of BMI stratified cut-offs, assay heterogeneity, pre-test probability of hypopituitarism and lack of proper individual laboratory controls as reference population. In this review, current recommendations are discussed in light of recent available evidence. View Full-Text
Keywords: head trauma; hypopituitarism; diagnostic criteria head trauma; hypopituitarism; diagnostic criteria
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Klose, M.; Feldt-Rasmussen, U. Hypopituitarism in Traumatic Brain Injury—A Critical Note. J. Clin. Med. 2015, 4, 1480-1497.

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