Post-brain Injury fatigue? What blood tests to do for pituitary function after hospital discharge following a Brain Injury

Brain injury fatigue is common yet hormonal imbalance seems an unusual complication of brain injury. Depression must always be screened for.

The following tests (serum/plasma sample)* should be performed at 09:00:

• Men: Urea, creatinine and electrolytes Free T4 and thyroid-stimulating hormone (TSH), Cortisol Luteinising hormone (LH), follicle-stimulating hormone (FSH), testosterone, sex hormone-binding globulin, albumin.
• Women: Urea, creatinine and electrolytes Free T4 and TSH Cortisol* and In premenopausal women. If menstrual cycle has become abnormal post-TBI, check LH, FSH, oestradiol In postmenopausal women FSH.
  *If the patient is taking an oestrogen-containing oral contraceptive pill or oral hormone replacement therapy, we recommend seeking endocrine advice prior to assessing hypothalamic–pituitary–adrenal axis function.

Taken from the 2017 British Neurotrauma Group Guidance.

Tan CL, Alavi SA, Baldeweg SE, Belli A, Carson A, Feeney C, Goldstone AP, Greenwood R, Menon DK, Simpson HL, Toogood AA, Gurnell M, Hutchinson PJ. The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance. J Neurol Neurosurg Psychiatry. 2017 Nov;88(11). https://jnnp.bmj.com/content/88/11/971.long