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Traumatic Brain Injury And Hormonal Dysfunction

Did you know pituitary gland damage is common in traumatic brain injury (TBI) cases? According to a recent article discussing pituitary gland damage in TBI cases:

Many studies have shown that a high percentage of patients who suffer mild, moderate, or severe TBIs may have some form of pituitary dysfunction in the first three months following the injury. While most of these patients’ symptoms go away over the following nine months or so, many still have pituitary hormone dysfunction by the end of a year.

Recent medical research shows a significant number of TBI patients actually continue to suffer chronic, or long-term, pituitary gland injury:

Based on data in the current literature, approximately 15%–20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions.

That’s a significant percentage of TBI patients who continue to suffer long-term hormonal problems from their injury. This research is important for a couple of reasons:

  1. The findings allow physicians to better treat TBI and its impacts upon the patient.
  2. The findings provide another objective measure to diagnose TBI.

What is the Pituitary Gland?

The pituitary gland is often referred to as the “master gland.” Many medical professionals consider it the most important part of your endocrine system as it controls the functions of many other glands. The pituitary gland sits in a bony area behind the bridge of your nose. The pituitary gland produces essential growth hormones, puberty hormones, thyroid stimulating hormone and hormones which affect adrenal hormones.

How can Pituitary Gland injury affect the patient?

The article Head Cases: Pituitary Incidents Arising From Traumatic Brain Injury summarizes the impact of TBI upon a patient’s endocrine system:

Trauma to the brain may interfere with the normal production and regulation of the hormonal processes of the hypothalamus and pituitary glands. The hypothalamus and pituitary are the most vulnerable and often most affected by brain injury. Depending on the injury, problems that can occur right away include adrenal insufficiency, diabetes insipidus, and hyponatremia. Other problems may not surface until months or years later, and the most common are growth and gonadotropin hormone deficiencies leading to symptoms such as growth problems, fatigue, weight gain, low blood pressure, low libido, loss of muscle mass, and amenorrhea.

The impact of these injuries can be tremendous, especially upon children with TBI. Statistics from the Centers for Disease Control indicate indicate over 2.5 million people visit emergency rooms annually for head trauma. Personally, I think the statistics under-report the problem. I believe the actual number of people who suffer a head trauma is much higher. Many head injury victims do not seek medical care.

For the youngest children, falls cause the most injuries. For young adults, car accidents are a primary cause of injuries. The impact of a pituitary gland injury on a growing child can produce long-lasting effects. If medical professionals are aware of pituitary dysfunction, they can provide appropriate treatment for the patient.

Can testing provide an objective measure for brain injury?

Traumatic brain injuries are frequently referred to as “invisible injuries.” The person suffering a TBI from an accident may look perfectly normal. Because of that, brain injuries are often misunderstand by medical professionals. Friends, family, and others, may even doubt the patient because of his or her normal appearance. Our office has  resolved several brain injury claims from automobile accidents this year. In most of these cases, our client looked fine. We worked hard to develop the medical evidence supporting the injuries.

In an earlier post titled, New Study Asks: How Do Emergency Rooms Evaluate Traumatic Brain Injury?, I discussed the difficulty of assessing TBI. In many TBI cases, traditional tests like x-rays or MRIs can appear normal.

Can a laboratory blood screen for hormonal deficiencies provide objective evidence of a brain injury? That’s the question asked by some medical researchers. In the legal context, a blood screen might provide valuable objective evidence of injury. When should blood screenings be performed? Who should be tested? The recent Head Cases article states:

There is no debate that TBI-related endocrine dysfunction is a widely missed diagnosis. The healthcare providers who are first to treat these injuries are often unaware of potential long-term effects.

“Emergency room staff [and primary care doctors] are the ones seeing the kids come in with the head injuries and they’re thinking concussion and all the old school stuff about concussion-causing headaches, maybe some dizziness, and vomiting,” says [neuroendocrinologist Gary] Wand. “They’re thinking the kids are going to get better, and they’re just not aware that you can have these hormonal changes.”

Diagnosing post-TBI dysfunction involves serum screening tests including: 0800 cortisol levels, thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormone, IGF, free thyroxine, testosterone for male patients, and estradiol for females. However, there have been several published guidelines on the recommended screening intervals and even treatment.

A research study published by the National Institute of Health also addresses the issue:

Because TBI is an important cause of hypopituitarism, the first approach could involve testing all patients with a history of TBI. However, this strategy is not cost-effective and would result in unnecessary consumption of health care resources in the community. Therefore, the most important clinical challenge is to determine which TBI patients should be screened for pituitary dysfunction.

From both a medical and legal standpoint, I would like to see a protocol developed for this screening. In our cases, we are frequently faced with (1) challenges concerning objective proof of injury that could be assisted by a blood screen; and, (2) long-term TBI problems which could be attributable to endocrine system injury.