High Risk of Hypogonadism After Traumatic Brain Injury: Clinical Implications
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Several recent studies have convincingly documented a close association between traumatic brain injury (TBI) and pituitary dysfunction. Post-traumatic hypogonadism is very common in the acute post-TBI phase, though most cases recover within six to twelve months following trauma. The functional significance of early hypogonadism, which may reflect adaptation to acute illness, is not known. Hypogonadism persists, however, in 10–17% of long-term survivors. Sex steroid deficiency has implications beyond psychosexual function and fertility for survivors of TBI. Muscle weakness may impair functional recovery from trauma and osteoporosis may be exacerbated by immobility secondary to trauma. Identification and appropriate and timely management of post-traumatic hypogonadism is important in order to optimise patient recovery from head trauma, improve quality of life and avoid the long-term adverse consequences of untreated sex steroid deficiency.
Key Wordstraumatic brain injury hypogonadism hypopituitarism
traumatic brain injury
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- 1.Klasbeek WD, McLaurin RL, Harris BSH, Miller JD. The national head and spinal cord survey findings. J Neurosurg 1980;53:519–531.Google Scholar
- 6.Agha A, Roger B, Mylotte D, Taleb F, Tormey W, Phillips J, Thompson CJ. Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clin Endocrinol (Oxf) 2004;60:584–591.Google Scholar
- 9.Aimaretti G, Ambrosio MR, Di Somma C, Fusco A, Cannavo S, Gasperi M, Scaroni C, De Marinis L, Benvenga S, Uberti ECD, Lombardi G, Mantero F, Martino E, Giordano G, Ghigo E. Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: Screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004;61:320–326.CrossRefGoogle Scholar
- 10.Popovic V, Pekic S, Pavlovic D, Maric N, Jasovic-Gasic M, Djurovic B, Medic Stojanoska M, Zivkovic V, Stojanovic M, Doknic M, Milic N, Djurovic M, Dieguez C, Casanueva FF. Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress. J Endocrinol Invest 2004;27:1048–1054.PubMedGoogle Scholar
- 17.Woolf PD, Hamill RW, McDonald JV, Lee LA, Kelly M. Transient hypogonadotrophic hypogonadism after head trauma : Effects on steroid precursors and correlation with sympathetic nervous system activity. Clin Endocrinol (Oxf) 1986;25:265–274.Google Scholar
- 24.Agha A, Phillips J, O’Kelly P, Tormey W, Thompson CJ. The natural history of post-traumatic hypopituitarism: Implications for assessment and treatment. Am J Med 2005 (in press).Google Scholar
- 27.Yaun X-Q, Wade CE. Neuroendocrine abnormalities in patients with traumatic brain injury. Front Neuroendocrinol 1991;12:209–230.Google Scholar
- 37.Pavord SR, Girach A, Price DE, Absalom SR, Falconer-Smith J, Howlett TA. A retrospective audit of the combined pituitary function test, using the insulin stress test, TRH and GnRH in a district laboratory. Clin Endocrinol(Oxf) 1992;36:135–139.Google Scholar
- 38.Burke CW. The pituitary megatest: Outdated? Clin Endocrinol (Oxf) 1992;36:133–134.Google Scholar
- 39.Westood ME, Butler GE, McLellan AC, Barth JH. The combined pituitary function test in children: An evaluation of the clinical usefulness of TRH and LHRH stimulation tests through a retrospective analysis of one hundred and twenty six cases. Clin Endocrinol (Oxf) 2000;52:727–735.Google Scholar