Hormonal replacement in patients with brain injury-induced hypopituitarism: who, when and how to treat?

Traumatic brain injury is one of the main causes of death, as well as, physical and cognitive disabilities in young adults. Recent studies have demonstrated head injury (TBI and SAH) as a frequent cause of hypopituitarism. Since hormonal deficits may contribute to the outcome of the patient, it is important to establish guidelines of who, when, and how to treat. The probability of developing hypopituitarism has been based on the severity of the TBI. Yet discrepancies in recent studies display that minimal TBI can also result in hypopituitarism. Thus patients with moderate to severe TBI must be screened and those with minimal TBI monitored for hypopituitarism. The temporal relationship between TBI and occurrence of hypopituitarism is observed in 3 phases-acute, recovery, and chronic. Clear hormonal deficits should be treated, but the question arises concerning subtle abnormalities and their role in the outcome of TBI patients.