Hormonal diseases after traumatic brain injury

Czech version

Authors: J. Čáp
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc.
Published in: Vnitř Lék 2006; 52(10): 941-946
Category: Review

Overview

Traumatic brain injury represents major medical and social problem in all developed countries. Its incidence is about 200 per 100 000 inhabitants per year. In the acute phase immediately after injury the posterior pituitary dysfunction is well known. The incidence of severe, grossly hypernatremic, cases of diabetes insipidus (DI) is about 3 %, les severe form of ADH insufficiency was recognized in 21-26 %. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) was described in about 14 %. These changes are transient in most cases, persisting DI has an incidence of 5-7 % and SIADH cases recover almost always. Since the beginning of this century several series evaluating prospectively all patents after moderate a severe TBI have been published. The permanent hypopituitarism was found in one quarter to one half of them. The most common turned out to be the growth hormone (17.6 %) and gonadotropic (13.4 %) deficiency. Less common is the corticotropic (8.4 %) and thyrotropic (4.3 %) insufficiency. In the majority of patient an isolated dysfunction was discovered. In 9 %, however, a combined failure of two or more pituitary was present. This paper describes the minimum investigation needed to diagnose hypopituitary patient after TBI, who may profit from substitution therapy.

Key words:
traumatic brain injury - TBI - hypopituitarism - diagnosis - substitution

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