Post Traumatic Hypopituitarism (a)


Objectives
• Understand the Pituitary Gland and its susceptible to injury
• Identify the patients appropriate for Pituitary Hormone Screening
• Understand the principle pituitary hormones and how deficiency can lead to
symptoms that interfere with rehabilitation progress and potential
• Understand the time frame for treatment with Growth Hormone
Supplementation
• Understand interpretation of Pituitary testing
• Understand the endocrine Society Guidelines for Pituitary Gland Evaluation in
TBI

BRAIN

BRAIN2

BRAIN4

BRAIN5

Case #1 Tom
MVA 11/9/2013
Severe TBI, DAI, SDH, bifrontal, bitemporal, and
biparietal lobe injury
Initial GCS 3
Coma x 1+ month
Autonomic Storming
Low Testosterone
P r o l o n g e d R L A I V ! ! # @ * . .
Depakote finally worked.
Low Testosterone
Low Vitamin D
18 mos – Referred to Neuroendocrinology, Dr.
Alzohaile

Case #2 Kim
MVA 1/16/13
Severe TBI, GCS 3
(DAI, SAH, ICH)
RLA II on admit to Special Tree 2/6/13
12 mos later– Psychosis, decline in motor
function, decline in cognition
Labs – Hypothyroid
Gradual improvement on Levothroid…
18 mos – Referred to Neuroendocrinology for
PTH
9

History
• Neuroendocrine disorders, primarily hypopituitarism, was first diagnosed by the
German researcher Cyran in 1918 1-3.
• Damage to the hypothalamus and pituitary gland following trauma was often not
diagnosed until the post mortem examination
• Recent research indicates neuroendocrine disorders vary post traumatic brain injury
(TBI)
• In the early 1950’s, the incidence of hypopituitarism post injury was thought to be 1%;
however, the rate has recently been quoted between 20 and 70%

Anterior Pituitary
• Hypothalamic releasing factors correspond with the hormones released by the
anterior pituitary and include:
• Growth hormone releasing hormone-growth hormone release Somatostatindecreases
release of growth hormone
• Thyrotropic releasing hormone- thyroid hormone release
• LHRH/GnRH -FSH and LH release
• Corticotropic releasing hormone -ACTH release
• Prolactin releasing factor (PRF) and thyrotropin-releasing hormone (TRH) – prolactin

Posterior Pituitary
The posterior lobe is responsible for the secretion and storage of 2 hormones:
• Vasopressin (or antidiuretic hormone (ADH)) promotes water retention in the kidneys,
which allows for concentration of urine
• Oxytocin allows for milk let down in the breast and causes uterine contractions during
labor

Pituitary Blood Supply
• The majority of the gland’s blood supply
comes from the long hypophyseal vessels
• The inferior hypophyseal artery supplies
blood to the entire neurohypophysis and to a
small section of the adenohypophysis

BRAIN6

 

(TO BE CONTINUED)

Jennifer E. Doble, MD
Associates in Physical Medicine and Rehabilitation
St. Joseph Mercy Hospital, Ann Arbor
Medical Director, NeuroRestorative Michigan

 

About sooteris kyritsis

Job title: (f)PHELLOW OF SOPHIA Profession: RESEARCHER Company: ANTHROOPISMOS Favorite quote: "ITS TIME FOR KOSMOPOLITANS(=HELLINES) TO FLY IN SPACE." Interested in: Activity Partners, Friends Fashion: Classic Humor: Friendly Places lived: EN THE HIGHLANDS OF KOSMOS THROUGH THE DARKNESS OF AMENTHE
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1 Response to Post Traumatic Hypopituitarism (a)

  1. HOPE TBI says:

    Thank you for posting this. Interesting information I have been reading about secondary to my TBI. Lots of endocrine changes still.

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