eMedicine Specialties > Physical Medicine and Rehabilitation > Traumatic Brain Injury

Post Head Injury Endocrine Complications: Follow-up

Author: Milton J Klein, DO, MBA, Consulting Physiatrist, Sewickley Valley Hospital, Allegheny General Hospital, Harmarville Rehabilitation Center, Ohio Valley General Hospital, and Aliquippa Community Hospital
Contributor Information and Disclosures

Updated: Jan 5, 2009

Follow-up

Further Inpatient Care

  • The clinical response of the patient after treatment has been instituted is the most important factor in determining the necessity of additional treatment. Follow-up endocrine studies (ie, hormonal levels) are necessary at least weekly until homeostasis has been achieved. Serum electrolytes, BUN, and creatinine levels need to be assessed at least daily until normalized, and then these levels should be monitored at routine intervals.

Further Outpatient Care

  • The outpatient follow-up care of these patients is individualized, depending on the endocrine problem under treatment and the patient's metabolic stability.

Inpatient & Outpatient Medications

  • As stated previously, medication management consists primarily of hormone replacement until clinical response and normal serum levels have been achieved. In most cases, the HRT continues on a long-term outpatient basis. Most inpatients with associated electrolyte disorders are stabilized with intravenous electrolyte therapy before hospital discharge, and no further medication management is necessary.

Deterrence

  • No deterrence/prevention program exists for endocrine complications following traumatic brain injury (TBI). Early recognition of these problems through a high index of suspicion, close monitoring of serum electrolyte balance, and prompt corrective treatment minimizes any negative impact these complications have on the rehabilitation outcome.

Complications

  • The most significant complication is failure to recognize these treatable endocrine complications, ultimately prolonging the rehabilitation program and decreasing the patient's functional outcome following traumatic brain injury (TBI).
  • Osmotic demyelination of the CNS, caused by an excessively rapid correction of hyponatremia with IV hypertonic saline, is an unusual complication of TBI, albeit a serious and sometimes lethal one.

Prognosis

  • The prognosis for the patient with endocrine complications following traumatic brain injury (TBI) is good to excellent, assuming these sometimes subtle problems are diagnosed and treated promptly. Failure to recognize and treat these problems negatively affects the rehabilitation progress and eventually the long-term functional outcome.17,18

Patient Education

  • Depending on the level of patient cognitive impairment, the patient and his or her caregivers/guardians are advised to be aware of any changes exhibited by the patients, such as unexplained patient lethargy, decreased tolerance to activity, or cold intolerance. These particular problems require immediate notification of the attending physician. The patient should undergo physician reevaluation and, if necessary, an endocrine workup. Rapid corrective hormonal replacement therapy then can be initiated and monitored at a follow-up session with the treating physician.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Anatomy of the Endocrine System.

Miscellaneous

Medicolegal Pitfalls

  • The most significant medical/legal pitfall is delayed diagnosis or failure to diagnose neuroendocrine abnormalities following traumatic brain injury (TBI), especially in a patient with severe cognitive impairment. Should this problem remain untreated, the progress and eventual outcome of the patient's rehabilitation may be significantly compromised. Nonreversible loss of function would be costly in terms of patient care needs and, more importantly, the patient's quality of life.
 


More on Post Head Injury Endocrine Complications

Overview: Post Head Injury Endocrine Complications
Differential Diagnoses & Workup: Post Head Injury Endocrine Complications
Treatment & Medication: Post Head Injury Endocrine Complications
Follow-up: Post Head Injury Endocrine Complications
Multimedia: Post Head Injury Endocrine Complications
References
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References

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Further Reading

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Keywords

hormone, hormones, adrenal, endocrine, TBI, head injury, adrenal gland, traumatic brain injury, pituitary gland, endocrine system, hypothalamus, adrenal insufficiency, adrenal glands, pituitary glands, hypopituitarism, panhypopituitarism, posttraumatic brain injury endocrine complications, post-traumatic brain injury endocrine complications, endocrine complications following TBI

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Contributor Information and Disclosures

Author

Milton J Klein, DO, MBA, Consulting Physiatrist, Sewickley Valley Hospital, Allegheny General Hospital, Harmarville Rehabilitation Center, Ohio Valley General Hospital, and Aliquippa Community Hospital
Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Patrick J Potter, BSc, MD, FRCP(C), Associate Professor, Physical Medicine and Rehabilitation, The University of Western Ontario; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre
Patrick J Potter, BSc, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kat Kolaski, MD, Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine
Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

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