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Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

Introducción: el traumatismo craneoencefálico representa un grave problema de salud pública, ya que cada vez es mayor el número de personas que por diversas razones se ven afectadas (accidentes de tránsito, caídas, violencia, deportes), más en países como Colombia, donde las tasas de mortalidad y morbilidad son verdaderamente alarmantes. Una de las consecuencias más serias a las que se ven enfrentados tanto el paciente como sus cuidadores son las alteraciones neuropsiquiátricas, ya que impactan de gran manera el tratamiento, el proceso de rehabilitación y a sus cuidadores. Objetivo: intentar dar una visión resumida y práctica de los principales trastornos psiquiátricos después de un traumatismo craneoencefálico (pos-TEC), mencionando algunos elementos fi siopatológicos y de enfoque del tratamiento. Método: se revisan los principales trastornos neuropsiquiátricos pos-TEC, usando textos importantes, conocidos y recientes sobre el tema. Conclusiones: se ha identifi cado que los pacientes pos-TEC presentan anomalías neuropsicológicas y de neuroimágenes sutiles, pero signifi cativas que parecen estar en relación con los síntomas que se refi eren. Las terapias de orientación cognitiva han dado resultados favorables y, de hecho la educación temprana acerca de cómo afrontar las molestias posteriores al TEC disminuye de manera importante el desarrollo de este síndrome. Introduction: Traumatic brain injury (TBI) is a serious public health problem, affecting more people everyday for various reasons (car accidents, falls, violence, sports), specially in countries like Colombia where morbimortality rates are truly alarming. The patient and caregivers are confronted with serious consequences such as neuropsychiatric disorders that impact heavily on the treatment, the rehabilitation process and the caregivers lives. Objective: To give a practical description of the main psychiatric disorders present after traumatic brain injuries together with available treatments, including also some of the physiopathological elements involved. Method: Review of current, well-known literature on the subject. Conclusions: Post-TBI patients exhibit subtle, although signifi cant, neuropsychological and neuroimaging anomalies, since they appear to be related to the symptoms patients describe. Cognitive oriented therapies have shown good results, and in fact, early education on how to manage discomfort following TBI diminishes the risk of presenting post-concussion syndrome.

Introducción: el manejo farmacológico de alteraciones neuropsiquiátricas del paciente con daño cerebral traumático (DCT) parte del supuesto de una cuidadosa valoración clínica. Previo a toda intervención farmacológica debe ser observada la psicopatología particular del paciente, su entorno, los antecedentes y los factores relacionados con su vida diaria que puedan ser susceptibles de manejo no farmacológico, ya que este conocimiento permite la adecuación de la terapia a la individualidad del paciente. Objetivo: señalar cuáles son algunas de las alteraciones directamente relacionadas con el DTC, así como las posibles ganancias secundarias voluntarias o involuntarias generadas por éste. Método: se presentan los aspectos generales del uso de psicofármacos en pacientes con DCT. Conclusiones: alteraciones como cuadros afectivos secundarios al daño cerebral, apatía, trastornos ansiosos, etc., requieren ser identifi cados y seguidos de manera periódica luego de que una intervención es instaurada. Además, los pacientes con DCT deben ser tratados por grupos interdisciplinarios con experiencia en este campo, ya que de esta manera la respuesta farmacológica es evaluada con herramientas clínicas de la neurociencia cognitiva y a la luz de un enfoque neuropsiquiátrico. Introduction: Pharmacological treatment of neuropsychiatric disorders in the patient with traumatic brain injury (TBI) stems from a careful clinical assessment. The patient’s psychopathology, history, environment and factors related to daily living susceptible of being treated non-pharmacologically should be assessed, prior to any pharmacological intervention. Objective: To point out which disorders are directly caused by TBI and which could be possible voluntary or involuntary secondary gains. Method: General aspects of the use of psychopharmacological agents in patients with TBI are described. Conclusions: Symptoms such as mood disorders due to brain damage, apathy, anxiety disorders, etc., need to be identifi ed, treated and followed up periodically. Patients with TBI should be treated by experienced interdisciplinary teams allowing the response to pharmacotherapy to be assessed using clinical tools from cognitive neuroscience from a neuropsychiatric perspective.