From the Guidelines
Laboratory evaluation for pituitary dysfunction after traumatic brain injury (TBI) should include essential tests such as morning cortisol, ACTH, TSH, free T4, and electrolytes, as well as consideration of LH, testosterone, FSH, and estrogen levels in patients with specific symptoms. The management of pituitary dysfunction following TBI requires a comprehensive approach to assess the entire hypothalamic-pituitary axis 1.
Necessary Laboratory Tests
- Evaluate ACTH (AM), cortisol (AM), TSH, free T4, and electrolytes as initial steps 1
- Consider standard-dose ACTH stimulation testing for indeterminate results (AM cortisol < 3 mg/dL and < 15 mg/dL) 1
- Consider evaluating LH and testosterone in males, FSH, and estrogen in premenopausal females with fatigue, loss of libido, mood changes, or oligomenorrhea 1
- MRI brain with or without contrast with pituitary or sellar cuts should be considered in all patients with new hormonal deficiencies, particularly those with multiple endocrine abnormalities, new severe headaches, or complaints of vision changes 1
Interventions
- Interventions should target specific hormone deficiencies, with treatments such as hydrocortisone for adrenal insufficiency, levothyroxine for hypothyroidism, testosterone replacement for men, estrogen with progesterone for premenopausal women, desmopressin for diabetes insipidus, and growth hormone replacement for documented deficiency
- Treatment should begin promptly for critical deficiencies like adrenal insufficiency and hypothyroidism, with regular monitoring of hormone levels, clinical symptoms, and potential side effects, and dose adjustments as needed 1
Quality of Life and Outcomes
Early identification and treatment of pituitary dysfunction can significantly improve recovery outcomes and quality of life after TBI, emphasizing the importance of comprehensive laboratory evaluation and targeted interventions 1.
From the Research
Laboratory Tests for Pituitary Dysfunction after TBI
The following laboratory tests are pertinent in a patient who suffered a TBI leading to pituitary dysfunction:
- Adrenal function tests to evaluate for adrenal insufficiency, such as cortisol and adrenocorticotropic hormone (ACTH) levels 2, 3
- Thyroid function tests to evaluate for hypothyroidism, such as thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels 3, 4
- Growth hormone and gonadotropin levels to evaluate for growth hormone and gonadotropin deficiencies 3, 4
- Osmolality and electrolyte panels to evaluate for water metabolism disorders, such as diabetes insipidus or syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2, 5
- Pituitary hormone levels, such as prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) 4
Interventions for Pituitary Dysfunction after TBI
The following interventions may be necessary for a patient with pituitary dysfunction following a TBI:
- Replacement therapy for hormonal deficiencies, such as cortisol, thyroid hormone, growth hormone, and gonadotropins 3, 4
- Management of water metabolism disorders, such as diabetes insipidus or SIADH, with fluid replacement and medication as needed 2, 5
- Close monitoring of electrolyte and osmolality levels to prevent complications such as seizures, reduced consciousness, and prolonged hospital stay 5
- Evaluation and management of secondary hypoadrenalism, hypothyroidism, and central diabetes insipidus 3