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Traumatic Brain Injury & Pituitary Dysfunction

Clinician's Brief (Capsule)

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Pituitary dysfunction, a relatively common complication of traumatic brain injury in humans, may afflict brain-injured dogs as well. It can go undetected on routine diagnostic testing and contribute to morbidity. Dogs (n = 17) with nonfatal head trauma and associated neurologic dysfunction were included in this study. 

Blood collected between <1 and 1460 days posttrauma was assayed for thyroid-stimulating hormone (TSH), total thyroxine (TT4), free T4 (FT4), basal cortisol, endogenous adrenocorticotrophic hormone (ACTH), and insulin-like growth factor-1 (IGF-1). Decreased serum IGF-1 concentration was noted in 7 cases; TT4 and TSH were decreased in 4 cases; and FT4 measured in 3 of these dogs was also decreased. Cortisol and ACTH were undetectable in 2 dogs; an ACTH stimulation test performed on 1 was consistent with hypoadrenocorticism. Both dogs had multiple concurrent deficiencies with associated clinical signs suggestive of panhypopituitarism. The authors conclude that dogs with traumatic brain injury may develop hypothalamic-anterior pituitary dysfunction that might require treatment. 

Commentary

Hypoadrenocorticism and hypothyroidism are well-recognized diseases that respond well to therapy. Testing for both diseases immediately following injury can be misleading. An ACTH stimulation test may not be diagnostic for several weeks following injury. A low TSH concentration in combination with a low free or total T4 can be consistent with euthyroid sick syndrome or secondary or tertiary hypothyroidism. Thus, diagnostics must be interpreted in combination with clinical signs.—Patty Lathan, DVM, DACVIM

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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