Vol.:(0123456789) 1 3 Pituitary https://doi.org/10.1007/s11102-019-01022-1 Dysregulation of the pituitary gland axes: an acute marker for a chronic process? Carlos Eduardo Jimenez‑Canizales 1,2,3  · Alejandro Pinzon‑Tovar 1,2,3,4  · Maria Isabel Cuellar Azuero 1,2,3 © Springer Science+Business Media, LLC, part of Springer Nature 2020 To the Editor, It has been a pleasure for us to review the special issue of your prestigious journal publication on the silent epidemic that is pituitary dysfunction in the context of traumatic brain injury, a subject of great interest to our interdisciplinary endocrinology research group. In the following letter, we extend to your information data from 2 of our studies which have yielded similar findings to those recently discussed by Pavlovic et al. [1]. We initially described pituitary hormone dysregulation in a group of patients who sustained severe Traumatic Brain Injury (TBI) and were committed to an intensive care unit in a hospital of reference in southern Colombia [2]. These individuals, who had varied forms of endocrine dysfunction, underwent neurocognitive evaluation according to a protocol that was designed and validated by our group to properly identify the affected cognitive domains that were specific to this population [3]. Between 1997 and 2003 we admitted a total of 2027 patients to our intensive care unit. 30% of these patients had traumatic brain injury and 21% were followed up by our hospital’s neurosurgery team. The initial phase of our study included 64 patients who suffered severe TBI, of which 89.1% were males, 43.8% were within the age group of 18 to 29 years and 76.6% sustained motorcycle accidents. Other common trauma etiologies were other motor vehicle accidents, falls from height and gunshot wounds. Among our study population, 29.7% presented initially with a GCS of 3/15 and the mean APACHE score was 17.8 (SD ± 4) [2]. All patients developed pituitary dysfunction affecting at least one axis in the acute phase of trauma, defined as the initial 48 h following admission. 65% were found to have IGF-1 levels below the laboratory’s reference value after adjustment for age and gender [2]. Gonadotroph dysfunction was reported in 57.8% of cases [2]. Thyrotroph dysfunc- tion occurred in 51.6% of cases as central hypothyroidism and in addition to this, 17.2% of patients had an abnormal thyroid hormone pattern consistent with euthyroid sick syn- drome [2]. Corticotroph dysfunction occurred in 6.4% of cases, however, the percentage of patients with gray zone cortisol levels was 32.8% [2]. Furthermore, 9.4% of patients fulfilled criteria for panhypopituitarism. Of note, analysis also revealed that mortality was found to be significantly higher in patients with IGF-1 levels below reference range as compared to those above the average threshold (42.8% vs. 17.6%) [2]. In phase 2 of our study, neurocognitive assessments have been performed to 6 of our survivor patients as of now. All of them have been found to have some sort of neurocogni- tive dysfunction, more prominently affecting memory, mood and executive function. Three patients were found to have mild anxiety and mild to moderate depression. Two of these patients developed impulsiveness, emotion dysregulation and aggression. All except one of our patients were found to have impaired memory, the one patient that was spared from memory disorders had the particularity of having both his somatotropic and corticotropic axes intact. Two patients with low IGF-1 levels presented executive dysfunction, mainly affecting processing speed and cognitive flexibility. * Carlos Eduardo Jimenez-Canizales caedjimenez@utp.edu.co Alejandro Pinzon-Tovar alepyto@yahoo.com Maria Isabel Cuellar Azuero mariaisa_119@hotmail.com 1 Department of Internal Medicine, Faculty of Health Sciences, Universidad Surcolombiana, Neiva, Colombia 2 Department of Internal Medicine and Endocrinology, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia 3 Semillero de Investigación en medicina interna (SIMI), MI Dneuropsy Research Group, Universidad Surcolombiana, Neiva, Colombia 4 Endho Colombia, Neiva, Colombia