title: Emerging pharmacotherapy for treatment of traumatic brain injury: targeting hypopituitarism and inflammation.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a common cause of morbidity and mortality in the developed world. In particular, TBI is an important cause of death and disability in young adults with consequences ranging from physical disabilities to long-term cognitive, behavioural, psychological and social defects.
  
  
  METHODS
  There is a large body of evidence that suggest that TBI conditions may adversely affect pituitary function in both the acute and chronic phases of recovery. Prevalence of hypopituitarism, from total to isolated pituitary deficiency, ranges from 5 to 90%. The time interval between TBI and pituitary function evaluation is one of the major factors responsible for variations in the prevalence of hypopituitarism reported. Diagnosis of hypopituitarism and accurate treatment of pituitary disorders offers the opportunity to improve mortality and outcome in TBI conditions.
  
  
  CONCLUSIONS
  The aim of this paper is to review the history and pathophysiology of TBI and to summarize the best evidence of TBI as a cause of pituitary deficiency. Moreover, in this article we will describe the multiple changes which occur within the hypothalamic-pituitary-thyroid axis in critical illness, giving rise to 'sick euthyroid syndrome', focus our attention on thyroid hormones circulating levels from the initial insult to critical illness.
authors.affiliation: a 1 University of Messina, Department of Biological and Environmental Sciences , Viale Ferdinando Stagno D'Alcontres, 31 - 98166 Messina, Italy +390906765208 ; salvator@unime.it.
authors.forename: Irene
authors.initials: I
authors.lastname: Paterniti
authors.affiliation: b 2 University of Messina, Department of Biological and Environmental Sciences , Messina, Italy.
authors.forename: Marika
authors.initials: M
authors.lastname: Cordaro
authors.affiliation: c 3 University of Messina, Department of Drug Sciences and Health Products , Messina, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Navarra
authors.affiliation: a 1 University of Messina, Department of Biological and Environmental Sciences , Viale Ferdinando Stagno D'Alcontres, 31 - 98166 Messina, Italy +390906765208 ; salvator@unime.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.affiliation: a 1 University of Messina, Department of Biological and Environmental Sciences , Viale Ferdinando Stagno D'Alcontres, 31 - 98166 Messina, Italy +390906765208 ; salvator@unime.it.|d 4 Saint Louis University School of Medicine, Department of Pharmacological and Physiological Science , USA.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cuzzocrea
mesh_terms: D000818:Animals; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D016638:Critical Illness; D015195:Drug Design; D005067:Euthyroid Sick Syndromes / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology; D010913:Pituitary-Adrenal System / Q000378:metabolism; D015995:Prevalence; D055815:Young Adult
keywords: T3; T4; hypopituitarism; secondary injury; traumatic brain injury