Post Head Injury Endocrine Complications Workup

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

Laboratory Studies

The hallmark of endocrine disorders is an abnormal serum level of either a particular hormone or the entire spectrum of associated hormones, such as in anterior hypopituitarism (panhypopituitarism).

Serial hormone assays may be used to determine the secretory pattern and to assess the hypothalamic regulation of pituitary function. All patients with traumatic brain injury (TBI) should undergo a baseline hormone evaluation at the time of hospital or intensive care unit (ICU) discharge, as well as at 3 months and 12 months post-TBI. The endocrinologist's workup may include provocative testing. Confirmatory testing of growth hormone (GH) deficiency is by assay of IGF-I. A low level of IGF-I in the absence of malnutrition is indicative of severe GH deficiency; however, aging or other factors (eg, liver disease, chronic renal disease, obesity, diabetes mellitus) can also cause a low level of IGF-I.

Careful clinical assessment of patients who have sustained TBI and who develop unexplained lethargy, generalized weakness, or anorexia should include an endocrine evaluation. Endocrine problems interfere with the progress of rehabilitation and are detrimental to the rehabilitation outcome if not recognized and treated promptly.

Laboratory/clinical screening studies of pituitary function include the following:

  • GH - Height, weight, and bone age (< 18 y)
  • IGF-I (0900)
  • Thyrotropin - Free T4 and T3 by radioimmunoassay (0900)
  • Corticotropin - Serum cortisol (0900 h)
  • Gonadotropins - Serum estradiol or testosterone (0900)
  • Prolactin - Serum prolactin
  • ADH - Serum/urine sodium, serum/urine osmolalities, and urine output

A study by Salomón-Estébanez et al indicated that children who have suffered mild to moderate TBI may not require routine evaluation for endocrine dysfunction. In the study, 36 pediatric patients, all of whom had suffered skull fracture or intracranial hemorrhage, including 36.6% who had sustained moderate to severe TBI, were assessed for pituitary dysfunction after a mean postinjury period of 3.3 years (with a mean age at assessment of 7.2 years). No pituitary dysfunction was found in these patients at follow-up, including in 4 patients with low serum IGF-I levels and two patients in whom serum cortisol levels were low and plasma adrenocorticotropic hormone (ACTH) levels were inappropriately normal. [27]

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Imaging Studies

See the list below:

  • Cranial magnetic resonance imaging (MRI) provides the most specific cross-sectional views of the hypothalamus and pituitary gland. [28] The diagnosis and treatment of endocrine complications following traumatic brain injury (TBI) are based on clinical findings and laboratory studies of overall pituitary hormonal regulation and of each endocrine gland.
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