Evaluation of neuroendocrine deficits following traumatic brain injury: The role of a neurorehabilitation specialist.

Traumatic brain injury (TBI) is a common injury that can lead to significant and prolonged morbidity. Growing evidence suggests hypopituitarism is prevalent after TBI and if left untreated, contributes to high symptom burden, limited rehabilitation participation, and poor functional recovery. The neurorehabilitation specialist is uniquely situated to identify patients at risk of hypopituitarism during all phases of recovery. There is significant overlap in symptom presentation between hypopituitarism and primary symptoms of TBI. Fatigue, disrupted sleep, altered cognition, weakness, exercise intolerance, and declining mental health can occur due to the brain injury or hypopituitarism, making clinical diagnosis challenging. Collaboration with endocrinologists can aid in organizing timely and appropriate workup, diagnosis, and initiation of hormone replacement therapy. Understanding the clinical features, timing, and trajectory of hypopituitarism after TBI allows neurorehabilitation specialists to facilitate diagnosis and treatment of hypopituitarism which may enhance rehabilitation engagement, improve symptom burden, and ultimately optimize recovery.