Hypothalamic-pituitary dysfunction in severe traumatic brain injury long-term outcomes
QIU Bing-hui
DU Jia-shu
ZHONG Qing-lei
ZHUO Jie
HE Shan
Abstract：The incidence of hypothalamic-pituitary dysfunction in patients with severe traumatic brain injury(sTBI)reaches up to 40%.However,it is often masked by clinical manifestations similar to those of sTBI,leading to underdiagnosis and misdiagnosis,which adversely affects long-term prognosis and quality of life.Therefore,integration into multimodal neurocritical care is essential.During the acute phase(within 72 h post-injury),15%-20%of patients develop hyponatremia,and adrenal cortical dysfunction may also occur.In such cases,the determination of free cortisol holds greater diagnostic value.In the chronic phase(beyond 3 months post-injury),18%-37%of patients exhibit growth hormone(GH)deficiency and hypothalamic-pituitary-gonadal(HPG)axis dysfunction.Although serum insulin-like growth factor-1(IGF-1)levels are associated with cognitive function,they are prone to misdiagnosis,resulting in an average diagnostic delay of 14 months.Clinical management requires three major shifts:transitioning from ensuring patient survival in the acute phase to focusing on long-term prognosis and functional outcomes,moving from hormone replacement therapy toward neural repair,and evolving from a solely neurosurgical approach to a multidisciplinary integration involving neurocritical care,endocrinology and rehabilitation medicine.These transformations are crucial for improving survival rates and quality of life.
Keywords：Brain injuriestraumaticHypothalamo-hypophyseal systemHyponatremiaAdrenal insufficiencyGrowth hormonePrognosisReview
Publication Date：2025-09-25
Online Publishing Date：2025-10-28(First online date of this platform, not the publication date of the document)
Pages：5( 779-783 )