Expert review of endocrinology & metabolism
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Expert Rev Endocrinol Metab · Sep 2011
Pituitary dysfunction after traumatic brain injury: screening and hormone replacement.
This article highlights the risk of hypopituitarism in survivors of traumatic brain injury (TBI), an underdiagnosed clinical problem. Clinical evidence shows that anterior pituitary dysfunction is common in TBI survivors evaluated at least 6 months after the TBI, with an estimated prevalence of up to 27.5%. ⋯ Since many of the symptoms of hypopituitarism are similar to those of TBI, it is important for clinicians to be aware of this clinical problem. Moreover, we will address questions such as when to screen and who should be screened, along with a discussion of current management of pituitary dysfunction in patients with TBI.
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Subclinical thyroid dysfunction occurs when peripheral thyroid hormone levels are within the normal laboratory reference range and the serum thyroid-stimulating hormone (TSH or thyrotropin) level is greater than normal (subclinical hypothyroidism) or less than normal (subclinical hyperthyroidism; TSH normal laboratory reference range: 0.3-5.0 mIU/l). For patients with subclinical hypothyroidism (serum TSH levels >10 mIU/l), thyroxine therapy is prescribed if other causes of TSH elevation and transient conditions have been excluded. ⋯ For patients with sustained subclinical hyperthyroidism (serum TSH levels <0.1 mIU/l), therapy is recommended, especially in older patients. Observation or selective therapy should be considered for patients with serum TSH levels between 0.1 and 0.3 mIU/l.