A 56 year-old male with a history of schizophrenia suffered traumatic brain injury after he was hit by a train. The patient sustained multiple facial fractures, pneumocephalus and C2/7 transverse processes fractures. He also had persistent hypotension with no response to standard treatment. Investigation revealed deficiency of anterior pituitary hormones resulting from pituitary axis disruption (Fig. 3). Levels of GH, Free T4, Insulin like Growth Factor-1 (IGF-1), and Testosterone were found to be low post injury while levels for thyrotropin (TSH), (ACTH), (LH) and FSH hormones remain unchanged.
Hypopituitarism is an insidious clinical manifestation, which can be extremely difficult to identify following a traumatic brain injury. Traumatic brain injury (TBI) is a cause of hypopituitarism in adults with growth hormone deficiency cited as one of the most frequent pituitary deficits. Although most acute cases of post-traumatic neuroendocrine dysfunction seem to be transient, permanent mild deficiency of pituitary hormones can be overlooked in chronic cases, as patients might have mild symptoms and/or other significant neurological disabilities. Pituitary insufficiency can complicate and delay the recovery process after TBI, impacting the outcome. Deficiencies in individual hormones result in imbalance in normal physiological processes equipped to deal with the stress after TBI. Early recognition and prompt treatment of pituitary insufficiency can facilitate the overall rehabilitation after TBI resulting in favorable outcomes. This work has been reported in line with the PROCESS criteria.
Both patients were placed on hormonal replacement therapy with glucocorticoid and levothyroxine. Following hormonal therapy, significant improvements in blood pressure, concentration, memory, depression, anxiety and fatigue were observed. Patients were discharged to a skilled TBI facility.