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Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury

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Abstract

The complex pathophysiology of traumatic brain injury (TBI) involves not only the primary mechanical event but also secondary insults such as hypotension, hypoxia, raised intracranial pressure and changes in cerebral blood flow and metabolism. It is increasingly evident that these initial insults as well as transient events and treatments during the early injury phase can impact hypothalamic-pituitary function both acutely and chronically after injury. In turn, untreated pituitary hormonal dysfunction itself can further hinder recovery from brain injury. Secondary adrenal insufficiency, although typically reversible, occurs in up to 50% of intubated TBI victims and is associated with lower systemic blood pressure. Chronic anterior hypopituitarism, although reversible in some patients, persists in 25–40% of moderate and severe TBI survivors and likely contributes to long-term neurobehavioral and quality of life impairment. While the rates and risk factors of acute and chronic pituitary dysfunction have been documented for moderate and severe TBI victims in numerous recent studies, the pathophysiology remains ill-defined. Herein we discuss the hypotheses and available data concerning hypothalamic-pituitary vulnerability in the setting of head injury. Four possible pathophysiological mechanisms are considered: (1) the primary brain injury event, (2) secondary brain insults, (3) the stress of critical illness and (4) medication effects. Although each of these factors appears to be important in determining which hormonal axes are affected, the severity of dysfunction, their time course and possible reversibility, this process remains incompletely understood.

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Authors and Affiliations

  1. Division of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Joshua R. Dusick

  2. Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA

    Christina Wang & Ronald Swerdloff

  3. Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA

    Christina Wang & Ronald Swerdloff

  4. Division of Endocrinology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Pejman Cohan

  5. Gonda Diabetes Center, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Pejman Cohan

  6. Neuro-Endocrine Tumor Center, John Wayne Cancer Institute, Saint John’s Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA

    Daniel F. Kelly

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  1. Joshua R. Dusick
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  2. Christina Wang
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  5. Daniel F. Kelly
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Correspondence to Daniel F. Kelly.

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Dusick, J.R., Wang, C., Cohan, P. et al. Chapter 1: pathophysiology of hypopituitarism in the setting of brain injury. Pituitary 15, 2–9 (2012). https://doi.org/10.1007/s11102-008-0130-6

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