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The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance
  1. Chin Lik Tan1,
  2. Seyed Alireza Alavi2,
  3. Stephanie E Baldeweg3,
  4. Antonio Belli4,
  5. Alan Carson5,
  6. Claire Feeney6,7,
  7. Anthony P Goldstone6,7,
  8. Richard Greenwood8,
  9. David K Menon9,
  10. Helen L Simpson3,
  11. Andrew A Toogood10,
  12. Mark Gurnell11,
  13. Peter J Hutchinson1
  1. 1Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
  2. 2Department of Neurosurgery, Queens Medical Centre, Nottingham, UK
  3. 3Department of Endocrinology, University College London Hospitals, London, UK
  4. 4NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
  5. 5Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  6. 6Centre for Neuropsychopharmacology and Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
  7. 7Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
  8. 8Institute of Neurology, University College London, London, UK
  9. 9Department of Medicine, Division of Anaesthesia, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
  10. 10Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, Edgbaston, UK
  11. 11Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
  1. Correspondence to Mark Gurnell, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; mg299{at}medschl.cam.ac.uk and Peter J Hutchinson, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK; pjah2{at}cam.ac.uk

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.

  • traumatic brain injury
  • pituitary dysfunction
  • screening
  • management

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Footnotes

  • Contributors CLT, MG and PJH led this work. SAA, SEB, AB, AC, CF, APG, RG, DKM, HLS and AAT contributed ideas. CLT, MG and PJH wrote the paper.

  • Funding A Belli is supported by the NIHR Surgical Reconstruction and Microbiology Research Centre; AP Goldstone is supported by the UK Medical Research Council; M Gurnell is supported by the NIHR Cambridge Biomedical Research Centre (BRC); PJ Hutchinson is supported by a NIHR Research Professorship and the NIHR Cambridge BRC; DK Menon is supported by a NIHR Senior Investigator Award and the NIHR Cambridge BRC.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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