Post Head Injury Endocrine Complications Follow-up

Updated: Feb 12, 2016
  • Author: Milton J Klein, DO, MBA; Chief Editor: Consuelo T Lorenzo, MD  more...
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Follow-up

Further Outpatient Care

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

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  • 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.
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Inpatient & Outpatient Medications

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  • 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.
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Deterrence

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  • 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.
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Complications

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  • 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.
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Prognosis

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  • 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. [19, 20]
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Patient Education

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  • 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 eMedicineHealth's Thyroid and Metabolism Center. Also, see eMedicineHealth's patient education article Anatomy of the Endocrine System.
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