Jornal Internacional de Medicina Física e Reabilitação
Acesso livre

Abstrato

Rehabilitation of a Patient with Panhypopituitarism Post Traumatic Brain Injury: A Case Report

Abdullah Alghaiheb

Traumatic Brain Injury (TBI) endocrinopathy have been reported previously in the literature. The pathophysiology of post TBI endocrinopathy remains elusive as many studies reveal the high prevalence of pituitary disruption post TBI. We present a case of a 39 years old male previously healthy who was involved in a road traffic accident which resulted in multiple skull fractures expressed on CT brain resulting in severe traumatic brain injury with an initial Glasgow Coma Scale (GCS) of 6/15 upon presentation in the hospital. He concurrently developed a pituitary dysfunction that lead to multiple endocrinopathies including diabetes insipidus, adrenal insufficiency, secondary hypothyroidism and central hypothermia. Which required hormone replacement therapy and multiple dietary requirements? The case is an example of the significant effect of post traumatic brain injury endocrine dysfunction on the patient's general wellbeing and his rehabilitation process. These findings emphasize the importance of early endocrine intervention and high vigilant care during the rehabilitation course. His rehabilitation program needed a multidisciplinary approach with physiatrists, endocrinologists, physical therapists, occupational therapists, neuropsychologists and dieticians. Functionally the patient reached Functional Independence Measure (FIM) of 6/7 requiring more time in feeding, grooming and dressing both upper and lower bodies. In other activities of daily living the patient needs minimal assistance with a FIM score of 4/7. Further progression of rehabilitation program was limited due to the cognitive impairment and the associated visual impairment from the trauma. We recommend further research to create a standardized endocrine screening protocol to detect the endocrinopathy early.