Last September, I reported on a fascinating presentation I heard by Brent Masel on Hypopituitarism following traumatic brain injury. This presentation was given at the North America Brain Injury Society (NABIS) annual legal medical seminar in Beaver Creek, Colorado. Dr. Masel and his colleagues have now published consensus guidelines on screening for hypopituitarism following traumatic brain injury which appeared in Brain Injury, 20 August 2005; 19(9): 711-724, the official research journal of the International Brain Injury Association. The consensus statement grew out of a meeting in June 2002 where international experts in endocrinology convened in California for a round-table discussion addressing the issue of acquired hypopituitarism following traumatic brain injury. At that meeting, the participants discussed whether there was sufficient data to show that patients with TBI were at an elevated risk of hypopituitarism, whether patients with TBI-induced hypopituitarism would have some resolution of symptoms as a result of hormone replacement therapy, how to identify the sub-population of patients with TBI-hypopituitarism, who should conduct testing and when and how to raise awareness of the problem among the medical community. After a number of years of researching these issues, a consensus statement has now been developed. The international experts found:
Results of recent and ongoing studies have made it clear that TBI poses substantial risk to pituitary function, perhaps even greater risks then previously believed. It is essential that patients with TBI be screened both prospectively and retrospectively for pituitary deficits-both isolated and multiple. Patients with demonstrable TBI-inducted hypopituitarism should initially receive critical replacement therapy such as with anti-diuretic hormone (adh), glucocorticoid and thyroid hormones. Gonadal and growth hormone replacement therapy should also be introduced if there are demonstrated deficiencies.