While I have not had the opportunity to examine hypopituitarism among patients with TBI, it would certainly provide some explanation in susceptibility to stress and an increased perception of pain.  The Hypothalamic–Pituitary–Adrenal (HPA) axis-activity (which results in an increase in the release of glucocorticoids) and sympathetic mechanisms are the main mechanisms at work in the reduction or inhibition of cellular and humoral immune responses.   When unusual or social stressors are present, it can compound the already existing stress from a wound, resulting in a dysregulation of the supersystem, leading to a decline in health, function, and well-being. Research by Coe & Laudenslager, 2007, Chapman, Tuckett, & Song, 2008, and Kemeny & Schedlowski, 2007 as well as myself found a negative emotional state can have a large impact on the ability of wounds to heal quickly. This has profound implications for the individual’s ability to heal after surgery or trauma. Even such things as routine stress can have a negative impact on the ability of wounds to heal. Moreover, exposure to acute psychological stress seems to trigger and increase in sympathetic adrenal activity, which in turn has an effect on the immune system.  If the HPA axis is challenged as a result of hypopituitarism, it could play a role in the person's ability to deal appropriately with stress.  The brain plays a major role in controlling the interpretation of what is stressful as well as the behavioral and physiological responses that are produced.. Brief periods of controllable stress do not have a large impact on physical or mental health, however, when a person experiences a lack of control and uncertainty, a chronic state of distress can ensue, that increases vulnerability to stress-related disorders.  I would be very interested in seeing more data related to this.

I have to admit in regard to children with TBI, there is no consensus in regard to routine endocrine referral or follow up in our institution. I think among ptuitary hormonal output, GH has received better attention though. in the just published review by Gardner & his group, it seems that long hormonal were less dramatic in comparison to non0functioning ademonas, but quality of life were moderate to severely affected nevertheless.  doi: 10.1530/EJE-14-0654.

We do see few number of cases especially among patients with basifrontal contusions, who remain in low GCS for a significant period but show significant improvement after starting replacement with fludrocortisone.