Traumatic Brain Injury Blog

Systematic Review of the Literature Shows the Prevalence of Pituitary Dysfunction following TBI

Over the past decade this blog has featured several articles addressing the growing recognition that neuroendocrine issues are an often-overlooked consequence of TBIs of all levels of severity, leaving patients with unnecessary chronic symptoms. We have discussed evolving guidance on the best methods to assess these issues (including the importance of “stimulation testing.” ) Unfortunately, outside of major medical centers (and military hospitals) awareness of this issue is not consistent.

As we have discussed, one of the most common neuroendocrine deficiencies is “growth hormone” deficiency.  The symptoms of growth hormone deficiency are common following TBI; they include “quality of life” problems including low energy level, increased emotional lability and irritability, and increased social isolation. They also include physical symptoms such as increased fat mass and decreased muscle strength. The good news is that when the cause of these symptoms is injury to the pituitary gland (often the stalk of the pituitary gland, which is particularly vulnerable) treatment may lead to improvement in the symptoms.  Growth hormone deficiency may be addressed through regular growth hormone injections. Although this treatment can be expensive and is sometimes required on a permanent basis, the increasing understanding of this issue in the field of neuroendocrinology has made it easier for patients to get insurance coverage. The latest issue of Neurosurgical Review features a “systematic review and meta-analysis”  of this issue, described as “acute and chronic hypopituitarism following traumatic brain injury.” Here’s a link to the article on PubMed, entitled Acute and chronic hypopituitarism following traumatic brain injury: a systematic review and meta-analysis. The review looks at 52 studies over the past several years, involving a total of 7367 participants.

The conclusion is consistent with what has been reported here, that there is

“a significant prevalence of pituitary axis dysfunction following TBI.”

The most prevalent dysfunction reported in the studies reviewed was growth hormone deficiency, with symptoms including “fatigue, decreased muscle mass, increased body fat, depression or anxiety, poor quality of life” and “reduced exercise capacity.”

Our hope is that as this potential consequence of TBI becomes common knowledge treatment providers will assess for this condition in patients with chronic symptoms and will treat it appropriately.