Can Symptoms of Hypopituitarism Present Years After a Brain Injury?

Question: 

My husband had a TBI in 1995. He suffers everyday from chronic headaches, body aches and pains, confusion, isolation, and depression. And he now has Type-II Diabetes. He is deteriorating and the doctors are looking at pain management, but what about the testing of his hormones? From the research I have done, his symptoms look very much like hypopituitarism. I cannot get the doctors to listen. I am currently trying to find a neuroendocrinologist. Do you have any suggestions? Surely, he does not have to suffer like this every day.

Answer: 

If your husband had hypopituitarism (a condition in which the pituitary gland does not produce normal amounts of some or all of its hormones), it would have been evident soon after his brain injury. The likelihood that he has developed hypopituitarism years after the injury as a result of the brain injury is slim to none. However, if you have concerns about this, he could be evaluated for his levels of sex hormone, growth hormone and thyroid hormone as well as any adrenal function impairments. A good endocrinologist should be able to do these tests easily.

If your husband truly has symptoms of hypopituitarism that have developed late after injury, I would think about unrelated tumors in the pituitary area which can also be associated with headaches. If he has not had a cerebral MRI since the onset of these symptoms, this might be somethingto consider.. It is important to separate the problems that are brain injury related from those that are not.

I also think it is critical to make sure that your husband’s care is being overseen by a doctor who specializes TBI and its long-term effects.

Posted on BrainLine June 9, 2014.

Comments (13)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

if a TBI leads to a pituitary gland disorder then that can definitely affect hypothalamus, thyroid, liver, etc, and cause type 2 diabetes. Full blood work and a brain MRI with contrast will reveal this most likely.

I think it's totally inaccurate to say symptoms will show up quickly.

My husband had a couple ski accident concussions in his late teens. His health decline was so gradual that he thought his fatigue, anxiety, body habitus, light body hair, low libido, etc. were normal. People adapt-- he thought it was normal that he had to take a nap everyday on his lunch break and that he lacked the strong sex drive and function of a twenty something dude.

We married about 10 years post concussions. He had no idea he was hypopit! Fortunately, I worked in Endocrinology at the time and quickly put all the pieces together after our wedding.

It's been a very very rough road. Being married to someone with this diagnosis is extremely challenging. If your spouse is newly diagnosed, find a good therapist who allows you to grieve the loss of all the things hypopit can take away. Our counselor tried to "fix" our marital struggles, but I did not find peace and acceptance until I grieved.

Had five known, sports mostly. I'm 53, worried it will effect me down the road?

Hypopituitarism showed up 3 years later in my husband. He was told it was from his TBI.

There is plenty of research to show that hypopituitarism can present years after a brain injury.

~~1. Benvenga, S et al, Hypopituitarism Secondary to Head Trauma, 2000, Journal Clin Endo and Metab “We learned, in fact, that head trauma can be minor and had occurred several years earlier, so that the patient may lose recollection of it.” http://jcem.endojournals.org/content/85/4/1353.long
2. Gordon, Mark (Clinical Professor, University of California) Post Traumatic Brain Injury Hormonal Deficiency Syndrome, 2006  “The first and foremost thing to do in order to diagnose, or rule out, post TBI hormonal deficiency syndrome is evaluate the patient – regardless of their age. Many of the patients that I see cannot even remember sustaining a head injury, because they were two or three when they were dropped on their head or when they accidentally banged their head on the wall and ended up in the emergency room.
http://www.worldhealth.net/pdf/Gordon_Thera10.pdf
3. Nachtigall, L B, Brain Injury and Pituitary Dysfunction, Massachussetts General Hospital Clinical Bulletin Vol 11: 2, 2005 (Re Benvenga article, “However, in about 5% of patients with posttraumatic hypopituitarism, there was an over 20-year lag period between injury and diagnosis.” “Longitudinal follow-up is necessary, as not all patients sustain permanent deficiencies and some develop hypopituitarism as a late manifestation many years after the initial event.” http://www.massgeneral.org/endocrine/assets/pdfs/neuroendocrine/clinicalcenterbulletin/2005_v11_i2_brain_injury_and_pituitary_dysfunction.pdf
4. Popovic V, Aimaretti G et al, Hypopituitarism following traumatic brain injury, Growth Horm IGF Res 2005 “Onset of pituitary deficits can evolve over years following injury.” http://www.ncbi.nlm.nih.gov/pubmed/15935980
5. Nirmalaraj K et al, Variable presentation of post-traumatic hypopituitarism, NZ Med J, 2008 “Although about 75% of PTHP cases are diagnosed within a year of TBI, delayed development of PTHP can also occur.” http://www.ncbi.nlm.nih.gov/pubmed/18256714
6. Bondanelli M et al, Hypopituitarism after traumatic brain injury, Eur J Endo, 2005. “Moreover, diminished pituitary hormone secretion, caused by damage to the pituitary and/or hypothalamus, may occur at any time after TBI.”
7. Alaca R et al, anterior hypopituitarism with unusual delayed onset of diabetes insipidus after penetrating head injury. Am J Phys Med Rehabil 81, 788-791
 

How soon can you start Namenda and Aricept after traumatic brain injury? My Dad is 86 yrs had his TBI from a fall approx. 1 month ago. The doctors are telling me it's too soon to start Namenda and Aricept . They have said he is stable and is at a plateau in rehab.

I had a TBI  6 years ago. I am a nurse. It took 2.5 years for a Dr  to believe me and actually run the endocrine tests required. Not a difficult ask. A few blood tests and you will know one way or the other. I work with 100's Dr still, and only one of them knew anything about hypopituitarism. It is not an every day thing. Don't give up. It took me 4 specialists to get the tests done, and  what do you know.... they came back positive!

I hope you find some help for your husband, and some one who will truly listen!

Same here, 6 years they tested for everything else but my hormones?
I had all the symptoms!
But was finally told it was just fibromyalgia?
7 years later anterior deficiency disease/ hypopituitism, along with severe adrenal deficiencies, I am pre diabetes, retaining fluids, as have since accident, and not getting any better..
My first endrocrinist was dismissive of my hormones, even though my igf1 was low, Igfbinding 3-low, hgh- low, somatropin low, tsh & t4 - low, among others, emg- perihial neuropathy, severe migraines, anxiety, pain etc..still looking for dr. To take this seriously in RI, its dismissive attitudes like the drs 1st post that leave us undiagnosed yrs later, Rita

This is very true! I have felt like an "outcast" also, not receiving the proper care.So many doctors put me off and send me off to another doctor to worry about my problems. None have cared enough to make sure that I'm getting the correct & deserved care that I feel I need. My whole body has been taken over by a brain and spinal cord injury. When help is offered like Symposiums & Conferences, they're so expensive and in an area of Colorado(Vail for instance) that we can't attend for the help! I'm scared to death to drive in the cold&snow, I'm scared to ski again(so I have to Watch others have fun). My healthcare doesn't recognize TBI & SCI enough to give me the care I've needed. Now I've had a stroke after the two above ailments. It's a Life Changing happening!!!

Most of us never get any help, healthcare or rehab let alone hormone tests. Without free healthcare, unless somebody is proved liable and pays up, we are outcasts and our needs are neglected - unless we're wealthy of course. Do many doctors provide free (pro-bono) healthcare for those who need it, if not why not? How about encouraging (or enforcing) a few hours a month for every doctor and hospital (and dentist, optician etc.) to provide some free care? And for the wealthiest medics how about a small extra tax that could help pay for tests and so on?

Can damage occur to the pituitary when boxes are dropped directly on top of the head from 10 feet up? Jammed my head down and causes my neck to tighten. Ever since been extremely fatigued with a craving for salt and thirsty all the time and low blood pressure with tachycardia. Other symptoms as well.

The person who said he doubted it possible is wrong! I recieved bad concussion in 2005 my hormones were never tested, except the which was very low at .37 but regardless of years of symptoms I was diagnosed with fibromyalgia?
7 years later new Dr's anterior pituitary disease and adrenal deficiencies, pre diabetes? And a whole mess of neurological, migraines, vision, electrolytes deficiencies among many other things before diagnosed.
In 2005 they did not screen for concussions at least to my knowledge, I've lived with chronic pain, depression, stress off the charts...and in RI still not much help.
Pay to test yr husbands or your own hormons.
Do not except a dead end diagnosis like fibromyalgia where they just stop looking for answers. Rita

I agree with Rita and those of you who have struggled with your symptoms and have been neglected or ignored by health care professionals for what ever reason. Immediately after an MVA, I trusted the ER Doc to perform tests necessary to detect and prevent permanent injury and the disabling symptoms that I experience 24/7 because of undiagnosed injuries and TBI. I learned that docs are humans and many docs have good intentions, but it's their job, not their life. As patients, it is our life that is at stake.
When I realized that the doctors that I had been treating with had limited knowledge and were specializing in what I term, "pieces and parts practicing", I realized that I had to figure out what had happened to me on my own. I'm not a "pieces and parts human". I'm a "whole" person. We are all "whole" people. What happens to a "part" affects the "whole". Thankful to a handful of physicians out of 20+ physicians (because of the "pieces and parts" philosophy) I started researching and discovered Neuroplasticity also known as Brain Plasticity. Dysautonomia, Autonomic Dysreflexia and PTH are what I'm trying to heal.
Long story short, along with Neurotherapies and specific PT programs, I stopped taking RX's and I compiled a list of amino acid supplements and other supplements that I credit to a very large part of my recovery.
Below is my list in order of effectiveness and importance for me. This is not a prescription for you. I am only sharing what worked for me:
N-Acetyl Tyrosine (NALT) along with vitamin C
7-Keto from 7-oxo-DHEA Acetate
Citicoline DCP Choline
Alpha Lipoic Acid
Acetyl L-Carnitine from Acetyl-L-Carnitine Hydrochloride
L-Carnitine as L-Carnitine Tartrate
Taurine
L-Arginine, L-Citrulline Complex (L-Arginine as L-Arginine HCI
N-Acetyl-L-Cysteine (N-A-C)
Vitex
Methyl Folate
Melatonin
Disclaimer: You assume all responsibility for trying any of the supplements listed above.
Every day is a new day and the body is constantly trying to renew.