Pituitary dysfunction after traumatic brain injury and cognitive disorders
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traumatic brain injury
cognitive dysfunction
growth hormone
adrenal Insufficiency
depression and psychosocial impact

How to Cite

Pinzón Tovar, A. ., Tovar Rubiano, C. ., & Jimenez Canizales, C. E. (2023). Pituitary dysfunction after traumatic brain injury and cognitive disorders. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 10(1). https://doi.org/10.53853/encr.10.1.753


Background: Traumatic brain injury (TBI) is a public health problem with severe neurological and cognitive sequelae that may be associated with endocrine pituitary dysfunction. Pituitary dysfunction increase morbidity, mortality and, depending on the affected axis, has variable cognitive and neurobehavioral repercussions that affect the rehabilitation process and the return to social life of the survivors.

Purpose: We carry out a review about relationship between pituitary hormonal alterations and neurocognitive alterations after the head trauma.

Methodology: A search of the literature was carried out using question, ¿which neurocognitive alterations are associated with post-traumatic brain injury and pituitary dysfunction? Using descriptors pituitary, hypopituitarism, traumatic brain injury, cognitive dysfunction, in the PubMed® and Scopus databases, the same question was asked for each of the pituitary axes.

Results: A total of 48 articles were found in these databases, mainly descriptive papers.

Conclusions: Pituitary disorders related to head trauma should be suspected and studied in patients with this history of importance for neurocognitive disorders and pituitary profile. The diagnosis of pituitary dysfunction should always be questioned in patients with TBI and mild and severe neurocognitive disorders.

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Tanriverdi F, Schneider HJ, Aimaretti G, Masel BE, Casanueva FF, Kelestimur F. Pituitary dysfunction after traumatic brain injury: A clinical and pathophysiological approach. Endocr Rev. 2015;36(3):305-42. https://doi.org/10.1210/er.2014-1065

Gilis-Januszewska A, Kluczy?ski ?, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms. Endocr Connect. 2020;9(5):R112-r23. https://doi.org/10.1530/EC-20-0117

Ministerio de Salud y Protección Social, Colciencias, Fundación MEDITECH. Guía de práctica clínica para diagnóstico y tratamiento de adultos con trauma craneoencefálico severo. SGSS-2014, Guía No. 30 GPC-TCE. Bogotá, Colombia: Ministerio de Salud y Protección Social; 2014.

Saavedra MÁ, Castillo ES, Rueda K, Paternina MF, Alvaran JM. Factores que impactan en la mortalidad de los pacientes con trauma que ingresan al servicio de urgencias. Rev Repertorio Med Cirugía. 2020;29(3):179-84. https://doi.org/10.31260/RepertMedCir.01217372.913

Benvenga S, Campenní A, Ruggeri RM, Trimarchi F. Clinical review 113: Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab. 2000;85(4):1353-61. https://doi.org/10.1210/jcem.85.4.6506

Lieberman SA, Oberoi AL, Gilkison CR, Masel BE, Urban RJ. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab. 2001;86(6):2752-6. https://doi.org/10.1210/jc.86.6.2752

Hacioglu A, Kelestimur F, Tanriverdi F. Long-term neuroendocrine consequences of traumatic brain injury and strategies for management. Expert Rev Endocrinol Metab. 2020;15(2):123-39. https://doi.org/10.1080/17446651.2020.1733411

Bondanelli M, De Marinis L, Ambrosio MR, Monesi M, Valle D, Zatelli MC, et al. Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma. 2004;21(6):685-96. https://doi.org/10.1089/0897715041269713

Bondanelli M, Ambrosio MR, Zatelli MC, de Marinis L, degli Uberti EC. Hypopituitarism after traumatic brain injury. Eur J Endocrinol. 2005;152(5):679-91. https://doi.org/10.1530/eje.1.01895

Kreitschmann-Andermahr I, Poll E, Gilsbach J. Neuroendocrinological dysfunction after subarachnoid haemorrhage. Neurol Rehabil. 2006;12(6):309-15.

Bondanelli M, Ambrosio MR, Cavazzini L, Bertocchi A, Zatelli MC, Carli A, et al. Anterior pituitary function may predict functional and cognitive outcome in patients with traumatic brain injury undergoing rehabilitation. J Neurotrauma. 2007;24(11):1687-97. https://doi.org/10.1089/neu.2007.0343

Kagerbauer SM, Rothoerl RD, Brawanski A. Pituitary dysfunction after aneurysmal subarachnoid hemorrhage. Neurol Res. 2007;29(3):283-8. https://doi.org/10.1179/016164107X165633

Acerini CL, Tasker RC. Neuroendocrine consequences of traumatic brain injury. J Pediatr Endocrinol Metab. 2008;21(7):611-9. https://doi.org/10.1515/JPEM.2008.21.7.611

Fernandez-Rodriguez E, Bernabeu I, Castro AI, Kelestimur F, Casanueva FF. Hypopituitarism following traumatic brain injury: Determining factors for diagnosis. Front Endocrinol. 2010;2. https://doi.org/10.3389/fendo.2011.00025

Maric NP, Doknic M, Pavlovic D, Pekic S, Stojanovic M, Jasovic-Gasic M, et al. Psychiatric and neuropsychological changes in growth hormone-deficient patients after traumatic brain injury in response to growth hormone therapy. J Endocrinol Invest. 2010;33(11):770-5. https://doi.org/10.1007/BF03350340

Pavlovic D, Pekic S, Stojanovic M, Zivkovic V, Djurovic B, Jovanovic V, et al. Chronic cognitive sequelae after traumatic brain injury are not related to growth hormone deficiency in adults. Eur J Neurol. 2010;17(5):696-702. https://doi.org/10.1111/j.1468-1331.2009.02910.x

Tanriverdi F, Unluhizarci K, Karaca Z, Casanueva FF, Kelestimur F. Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxers. Pituitary. 2010;13(2):111-4. https://doi.org/10.1007/s11102-009-0204-0

Quijano Martínez MC, Cuervo Cuesta MT. Alteraciones cognoscitivas después de un trauma craneoencefálico. Acta Colomb Psicol. 2011;14:71-80.

Dusick JR, Wang C, Cohan P, Swerdloff R, Kelly DF. Pathophysiology of hypopituitarism in the setting of brain injury. Pituitary. 2012;15(1):2-9. https://doi.org/10.1007/s11102-008-0130-6

Prodam F, Caputo M, Belcastro S, Garbaccio V, Zavattaro M, Samà MT, et al. Quality of life, mood disturbances and psychological parameters in adult patients with GH deficiency. Panminerva Med. 2012;54(4):323-31.

Wilkinson CW, Pagulayan KF, Petrie EC, Mayer CL, Colasurdo EA, Shofer JB, et al. High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol. 2012. https://doi.org/10.3389/fneur.2012.00011

Baxter D, Sharp DJ, Feeney C, Papadopoulou D, Ham TE, Jilka S, et al. Pituitary dysfunction after blast traumatic brain injury: The UK BIOSAP study. Ann Neurol. 2013;74(4):527-36. https://doi.org/10.1002/ana.23958

Rosario ER, Aqeel R, Brown MA, Sanchez G, Moore C, Patterson D. Hypothalamic-pituitary dysfunction following traumatic brain injury affects functional improvement during acute inpatient rehabilitation. J Head Trauma Rehabil. 2013;28(5):390-6. https://doi.org/10.1097/HTR.0b013e318250eac6

Rosario ER, Bustos MR, Moore C. Hypothalamic pituitary dysfunction following traumatic brain injury. Soc Care Neurodisability. 2013;4(3):134-46. https://doi.org/10.1108/SCN-12-2012-0006

Zaben M, El Ghoul W, Belli A. Post-traumatic head injury pituitary dysfunction. Disabil Rehabil. 2013;35(6):522-5. https://doi.org/10.3109/09638288.2012.697252

Pekic S, Popovic V. Alternative causes of hypopituitarism: Traumatic brain injury, cranial irradiation, and infections. Handbook Clin Neurol. 2014;124:271-90. https://doi.org/10.1016/B978-0-444-59602-4.00018-6

Richmond E, Rogol AD. Traumatic brain injury: Endocrine consequences in children and adults. Endocrine. 2014;45(1):3-8. https://doi.org/10.1007/s12020-013-0049-1

Zgaljardic DJ, Durham WJ, Mossberg KA, Foreman J, Joshipura K, Masel BE, et al. Neuropsychological and physiological correlates of fatigue following traumatic brain injury. Brain Inj. 2014;28(4):389-97. https://doi.org/10.3109/02699052.2014.884242

Greco T, Hovda DA, Prins ML. Adolescent TBI-induced hypopituitarism causes sexual dysfunction in adult male rats. Dev Neurobiol. 2015;75(2):193-202. https://doi.org/10.1002/dneu.22218

Ioachimescu AG, Hampstead BM, Moore A, Burgess E, Phillips LS. Growth hormone deficiency after mild combat-related traumatic brain injury. Pituitary. 2015;18(4):535-41. https://doi.org/10.1007/s11102-014-0606-5

Paterniti I, Cordaro M, Navarra M, Esposito E, Cuzzocrea S. Emerging pharmacotherapy for treatment of traumatic brain injury: Targeting hypopituitarism and inflammation. Expert Opin Emerg Drugs. 2015;20(4):583-96. https://doi.org/10.1517/14728214.2015.1058358

Renner CI. Interrelation between neuroendocrine disturbances and medical complications encountered during rehabilitation after TBI. J Clin Med. 2015;4(9):1815-40. https://doi.org/10.3390/jcm4091815

Tanriverdi F, Kelestimur F. Neuroendocrine disturbances after brain damage: An important and often undiagnosed disorder. J Clin Med. 2015;4(5):847-57. https://doi.org/10.3390/jcm4050847

Zihl J, Almeida OF. Neuropsychology of neuroendocrine dysregulation after traumatic brain injury. J Clin Med. 2015;4(5):1051-62. https://doi.org/10.3390/jcm4051051

Karaca Z, Tanriverdi F, Ünlühizarci K, Kelestimur F. GH and Pituitary Hormone Alterations after Traumatic Brain Injury. Prog Mol Biol Transl Sci. 2016;138:167-91. http://doi.org/10.1016/bs.pmbts.2015.10.010

Karamouzis I, Pagano L, Prodam F, Mele C, Zavattaro M, Busti A, et al. Clinical and diagnostic approach to patients with hypopituitarism due to traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). Endocrine. 2016;52(3):441-50. https://doi.org/10.1007/s12020-015-0796-2

Casano-Sancho P. Pituitary dysfunction after traumatic brain injury: Are there definitive data in children? Arch Dis Child. 2017;102(6):572-7. https://doi.org/10.1136/archdischild-2016-311609

Masel BE, Zgaljardic DJ, Forman J. Post-traumatic hypopituitarism and fatigue. Neuropsychol Rehabil. 2017;27(7):1071-9. https://doi.org/10.1080/09602011.2015.1125374

Tan CL, Alavi SA, Baldeweg SE, Belli A, Carson A, Feeney C, et al. The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance. J Neurol Neurosurg Psychiatry. 2017;88(11):971-81. https://doi.org/10.1136/jnnp-2016-315500

Undurti A, Colasurdo EA, Sikkema CL, Schultz JS, Peskind ER, Pagulayan KF, et al. Chronic hypopituitarism associated with increased postconcussive symptoms is prevalent after blast-induced mild traumatic brain injury. Front Neurol. 2018;9. https://doi.org/10.3389/fneur.2018.00072

Benvenga S. The history of pituitary dysfunction after traumatic brain injury. Pituitary. 2019;22(3):229-35. https://doi.org/10.1007/s11102-019-00949-9

Caputo M, Mele C, Prodam F, Marzullo P, Aimaretti G. Clinical picture and the treatment of TBI-induced hypopituitarism. Pituitary. 2019. https://doi.org/10.1007/s11102-019-00956-w

Grashow R, Weisskopf MG, Miller KK, Nathan DM, Zafonte R, Speizer FE, et al. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. JAMA Neurol. 2019;76(12):1428-38. https://doi.org/10.1001/jamaneurol.2019.2664

Gray S, Bilski T, Dieudonne B, Saeed S. Hypopituitarism After Traumatic Brain Injury. Cureus. 2019;11(3):e4163. https://doi.org/10.7759/cureus.4163

Kelestimur F. Neuroendocrine responses to traumatic brain injury. Pituitary. 2019;22(3):199-200. https://doi.org/10.1007/s11102-019-00963-x

Oberholzer M, Müri RM. Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review. Med Sci (Basel). 2019;7(3). https://doi.org/10.3390/medsci7030047

Ortiz JB, Sukhina A, Balkan B, Harootunian G, Adelson PD, Lewis KS, et al. Epidemiology of Pediatric Traumatic Brain Injury and Hypothalamic-Pituitary Disorders in Arizona. Front Neurol. 2019;10:1410. https://doi.org/10.3389/fneur.2019.01410

Pavlovic D, Pekic S, Stojanovic M, Popovic V. Traumatic brain injury: neuropathological, neurocognitive and neurobehavioral sequelae. Pituitary. 2019. https://doi.org/10.1007/s11102-019-00957-9

Temizkan S, Kelestimur F. A clinical and pathophysiological approach to traumatic brain injury-induced pituitary dysfunction. Pituitary. 2019;22(3):220-8. https://doi.org/10.1007/s11102-019-00941-3

Tudor RM, Thompson CJ. Posterior pituitary dysfunction following traumatic brain injury: review. Pituitary. 2019;22(3):296-304. https://doi.org/10.1007/s11102-018-0917-z

Jimenez-Canizales CE, Pinzon-Tovar A, Cuellar Azuero MI. Dysregulation of the pituitary gland axes: an acute marker for a chronic process? Pituitary. 2020;23(5):610-1. https://doi.org/10.1007/s11102-019-01022-1

Song YM. Traumatic brain injury-associated hypopituitarism-A case report with mini review. J Intern Med Taiwan. 2020;31(5):359-71.

Yuen KC, Masel BE, Reifschneider KL, Sheffield-Moore M, Urban RJ, Pyles RB. Alterations of the GH/IGF-I Axis and Gut Microbiome after Traumatic Brain Injury: A New Clinical Syndrome? J Clin Endocrinol Metab. 2020;105(9):E3054-E64. https://doi.org/10.1210/clinem/dgaa398

Lee J, Anderson LJ, Migula D, Yuen KC, McPeak L, Garcia JM. Experience of a Pituitary Clinic for US Military Veterans with Traumatic Brain Injury. J Endocr Soc. 2021;5(4). https://doi.org/10.1210/jendso/bvab005

Mele C, Pingue V, Caputo M, Zavattaro M, Pagano L, Prodam F, et al. Neuroinflammation and Hypothalamo-Pituitary Dysfunction: Focus of Traumatic Brain Injury. Int J Mol Sci. 2021;22(5). https://doi.org/10.3390/ijms22052686

Popp KH, Gröner JB, Stalla GK. Pituitary gland and contact sports. Gynakol Endokrinol. 2021;19(3):196-204. https://doi.org/10.1007/s10304-021-00397-4

Pinzón-Tovar A, González GA, Gonzales JC, Jimenez-Canizales CE. Adenohipófisis en la fase aguda del trauma craneoencefálico severo, estudio descriptivo. Acta Colomb Cuidado Intensivo. 2022. https://doi.org/10.1016/j.acci.2022.08.001

Arima H, Cheetham T, Christ-Crain M, Cooper D, Gurnell M, Drummond JB, et al. Changing the name of diabetes insipidus: a position statement of The Working Group for Renaming Diabetes Insipidus. Endocr Connect. 2022;11(11). https://doi.org/10.1530/EC-22-0378

DANE. Proyecciones de población. Bogotá, Colombia: DANE; 2022. https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/proyecciones-de-poblacion

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