There is evidence to suggest that patients with traumatic brain injury (TBI) and also those with spontaneous subarachnoid haemorrhage have an increased risk of pituitary failure, typically presenting late, with insidious onset.  The relative impact of deficiency states for these hormones varies considerably.

Antidiuretic hormone (ADH), Adrenocorticotropin (ACTH) and Thyroid-stimulating hormone (TSH) deficiencies have profound and potentially life threatening impacts on metabolic function. Protocols for screening and treatment are widely used in the general population. Treatment is well tolerated and there are no significant cost implications to implementation of a screening programme.

Follicle-stimulating hormone (FSH)/Luteinizing hormone (LH) deficiencies:

  • Pre or perimenopausal women.
    • Symptomatic and preventative benefits of sex hormone replacement therapy (HRT) are well established. Adverse effects are also recognised but are generally not a barrier to prescribing.
  • Postmenopausal women: treatment is not indicated.
  • Males under 50 years: testosterone deficiency secondary to FSH/LH deficiency in males is not associated with immediate health concerns but there are recognised symptomatic benefits to testosterone replacement in the non-TBI population. Adverse effects in the non-TBI population are not significant.
  • Males over 50 years: low testosterone levels are common in this group and in the non-TBI population.  Replacement is generally not considered appropriate.

Growth hormone (GH), melanocyte stimulating hormone (MSH) or oxytocin deficiency states in fully grown adults in the non-TBI population are not routinely treated. Screening tests are either complex in the case of GH or not well established and are of little benefit if treatment is not proposed.

Treatment of hyperprolactinaemia is associated with benefit in patients who are symptomatic.

It has been recommended that patients are screened at 3 months and 12 months post injury on the basis that 5% of patients identified as normal at 3 months may have identified deficits at 12 months.

Assessment and Management Protocols for Pituitary Impairment