TNF and systemic inflammatory response syndrome: Second, both TBI and SCI are often accompanied by a systemic inflammatory response syndrome that can cause hyperglycemia due to: 1) release of several cytokines (e.g., tumor necrosis factor alpha [TNF-α], interleukin [IL]-6, and CD11d) provoking hyperglycemia and insulin resistance; and 2) release of the corticotrophin-releasing hormone and release of adrenocorticotropic hormone from the anterior pituitary.10