The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance

Abstract

Pituitary dysfunction is a recognised, but potentially underdiagnosed complication of traumatic brain injury (TBI). Post-traumatic hypopituitarism (PTHP) can have major consequences for patients physically, psychologically, emotionally and socially, leading to reduced quality of life, depression and poor rehabilitation outcome. However, studies on the incidence of PTHP have yielded highly variable findings. The risk factors and pathophysiology of this condition are also not yet fully understood. There is currently no national consensus for the screening and detection of PTHP in patients with TBI, with practice likely varying significantly between centres. In view of this, a guidance development group consisting of expert clinicians involved in the care of patients with TBI, including neurosurgeons, neurologists, neurointensivists and endocrinologists, was convened to formulate national guidance with the aim of facilitating consistency and uniformity in the care of patients with TBI, and ensuring timely detection or exclusion of PTHP where appropriate. This article summarises the current literature on PTHP, and sets out guidance for the screening and management of pituitary dysfunction in adult patients with TBI. It is hoped that future research will lead to more definitive recommendations in the form of guidelines.

Endoplasmic reticulum stress induces apoptosis of arginine vasopressin neurons in central diabetes insipidus via PI3K/Akt pathway

“…The hypothalamo‐neurohypophyseal system (HNS), especially the pituitary stalk, serves as an essential role in water‐electrolyte regulation. Injury of the pituitary stalk could lead to imbalance of HNS and even cause severe hypothalamic dysfunction . Among these, central diabetes insipidus (CDI), characterized by polyuria, polydipsia, and low urine specific gravity, is a typical complication after surgery, trauma, or tumor around the hypothalamus …”

“…Injury of the pituitary stalk could lead to imbalance of HNS and even cause severe hypothalamic dysfunction. 1,2 Among these, central diabetes insipidus (CDI), characterized by polyuria, polydipsia, and low urine specific gravity, is a typical complication after surgery, trauma, or tumor around the hypothalamus. 3,4 In this work, we used a pituitary stalk electrical lesion (PEL) model to induce CDI condition, by targeting pituitary stalk without interrupting the adenohypophysis and portal circulation based on previous studies.…”

Experimental Evidence and Clinical Implications of Pituitary Adenoma Stem Cells

“…Moreover, tissue/organ regeneration after physical or immunological injuries implies the activation of PSCs (57,58) as described in pathological conditions which frequently cause transient or permanent hypopituitarism (e.g., altered embryonic formation, traumatic brain insults, tumor growth, or resection) (59). Since these clinical conditions constrain patients to a lifetime hormone replacement, a better understanding of the PSC regenerative potential and the mechanisms involved, could represent a therapeutic option for hypopituitarism.…”

Neuroendocrine consequences of traumatic brain injury and strategies for management

“…They suggested prospective screening for PD (28). The British Neurotrauma Group (BNG) suggested evaluation for PD in patients who were hospitalized for more than 48 hours or in those with signs or symptoms suggestive of PD (29).…”