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Should every patient with traumatic brain injury be referred to an endocrinologist?

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 318–319 (2007)Cite this article

Evidence from clinical studies has demonstrated that traumatic brain injury (TBI) is often the cause of hypopituitarism. Indeed, the risk of TBI-related hypopituitarism is much greater than previously suspected.1,2,3,4 TBI-related hypopituitarism remains underdiagnosed, however, often because of lack of awareness among the physicians most likely to see patients who might be suffering from this condition (i.e. general practitioners, endocrinologists and neurosurgeons). Given the epidemiology of TBI (∼91–332 cases per 100,000 inhabitants worldwide) and the high risk of panhypopituitarism or hypopituitarism of multiple hormones after head trauma (10–15%), it is clear that thousands of individuals experience low quality of life, and possibly impaired life expectancy, because of undiagnosed hypopituitarism.4,5 It is vital, therefore, that the medical community—particularly those physicians who take care of patients in either the acute or chronic phases of TBI—are aware of this increased risk of hypopituitarism. Awareness of the problem could aid appropriate screening of patients at risk,1,2 and is the first step towards the introduction of endocrinologists into the multidisciplinary team involved in the care of patients with TBI.

Data in the scientific literature have confirmed the increased endocrine interest in TBI, as well as the need to conduct controlled studies in order to understand whether the hormone deficiency that manifests after TBI is partially responsible for the poor quality of life and outcome of these patients.1,2,3 Postconcussion syndrome, and its signs and symptoms (headache, irritability, loss of memory, attention deficit, depression, fatigue, a low capacity for work, and cognitive alterations), are very common in the acute phase after TBI (∼30% of all cases). The signs and symptoms of postconcussion syndrome are also similar to those of panhypopituitarism or multiple-hormone hypopituitarism, and suggest that hormone deficiencies might mimic the sequelae of TBI. Consequently, pituitary hormone deficiencies could result in suboptimal rehabilitation for patients with TBI-induced hypopituitarism.6

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Authors and Affiliations

  1. G Aimaretti is Professor of Endocrinology in the Department of Clinical and Experimental Medicine, University of Piemonte Orientale, Novara, Italy,

    Gianluca Aimaretti

  2. E Ghigo is Professor of Endocrinology and Metabolism and Chairman of the Department of Internal Medicine, University of Turin, Turin, Italy.,

    Ezio Ghigo

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  1. Gianluca Aimaretti
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  2. Ezio Ghigo
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Correspondence to Gianluca Aimaretti.

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The authors declare no competing financial interests.

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Aimaretti, G., Ghigo, E. Should every patient with traumatic brain injury be referred to an endocrinologist?. Nat Rev Endocrinol 3, 318–319 (2007). https://doi.org/10.1038/ncpendmet0460

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