What endocrine axis assessment is recommended after moderate-severe TBI for long-term management?

• A. Pituitary axis evaluation (cortisol, thyroid, gonadal axis) due to risk of hypopituitarism; involve endocrinology
• B. Renal function assessment
• C. Cardiac axis evaluation
• D. Pulmonary function testing

Answer: (A)

Hypopituitarism is a recognized long-term risk after moderate to severe traumatic brain injury, so evaluating pituitary function is the key step in management. The pituitary and hypothalamus can be injured, leading to deficiencies across multiple hormonal axes that persist or emerge over time. Testing the major pituitary axes—cortisol (adrenal), thyroid (TSH and free T4), and gonadal (sex hormones with gonadotropins)—helps identify deficiencies that can influence energy, metabolism, mood, cognition, and recovery. Early detection allows appropriate hormone replacement and coordinated care with endocrinology, improving long-term outcomes. While renal, cardiac, and pulmonary assessments are important in TBI care, they do not address the endocrine sequelae that pituitary injury can cause.