Post Traumatic Hypopituitarism (a)

• 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
• Understand interpretation of Pituitary testing
• Understand the endocrine Society Guidelines for Pituitary Gland Evaluation in





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.

Case #2 Kim
MVA 1/16/13
Severe TBI, GCS 3
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

• 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
• 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

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




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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