Hypopituitarism After Brain Injury

Question: 

I keep hearing more and more about the need for people with TBI to see an endocrinologist to rule out hypopituitarism. Some studies I’ve read about have found improvements in cognitive outcome following the administration of growth hormone. It is hypothesized that it may be at least partially responsible for the fatigue so common after TBI. Can you shed some light on this topic?

Answer: 

Head injury can damage the pituitary gland and reduce production of two important hormones. The part of the pituitary gland that regulates growth hormone (GH) release is particularly vulnerable to the effects of head injury. Reduced production of GH causes symptoms of fatigue, reduced interest in sex, reduced stamina, anxiety, and depression. This happens in about 18 percent of people with brain injuries, most of whom had moderate to severe TBI. In most patients (90 percent), this condition resolves within a year.

The part of the pituitary gland that makes antiduretic hormone (ADH) is also vulnerable to injury. Reduced production of ADH can cause diabetes insipidus, which causes excessive urination and extreme thirst. (Unlike diabetes mellitus, diabetes insipidus does NOT raise blood sugar levels and is NOT treated with insulin.) Sometimes the resulting dehydration causes a sensation of fatigue. Diabetes insipidus occurs in about 25 percent of the people with brain injury, most of whom have had severe TBI. And again, in most patients, this condition resolves in less than a year.

Bazarian JJ, Cernak I, Noble-Haeusslein L, Potolicchio S, Temkin N. Long-Term Neurologic Outcomes After Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 2009; 24(6):439-451.

Posted on BrainLine July 11, 2011

Jeffrey Bazarian

Dr. Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center.

Comments

Doctors in London state that its unlikely that hypopot from tbi can show signs immediately without there being something else there before as it takes years they say for symptoms to show immediately following tbi or within six months. My son was so injured and showed signs at 4 months when investigated and the denial means he will be unable to secure compensation for this potential negative life changer

to the comment on April 2016- I am in the almost SAME EXACT BOAT. Head was turned also sitting in traffic. Im suffering for 1.5 yrs. Please tell me your near CT.. I can't find anyone to help me but I know this is the case

Two years ago I was struck from behind while at a traffic light.  I was on the way to work, eating a biscuit, while I was struck.  My head was in a turned position eating the biscuit, and this position along with a sudden jerk resulted in a whiplash injury that resulted in a concussion.  I was not aware of it at the time that I sustained a concussion because after five minutes of being hit I felt normal.  However, I believe that the accident resulted in nerve and brain damage that began a cycle of neurons being damaged in the brain.  

At the time, I thought that I had only bone, ligament, and nerve damage, thinking that the light-headedness, dizziness, faintness, rapid heart beats, etc. was all due to damaged nerves.  This is because a false reading of the MRI failed to read the damage to the pituitary gland that had ensued.

Having a concussion that never fully healed (because doctors misdiagnosed me and failed to read my scans accurately), along with a damaged pituitary resulted in hypopituitarism relating to growth hormone and testosterone.  Without these hormones in normal supply, especially growth hormone, my concussion was unable to heal completely.

The past two years has been trying.  Really hard.  A normal day ranges from 1.5 x harder to 5 x harder.  It depends on how tired my brain is.  I've put on a lot of weight due to almost no growth hormone.  The skin on my forehead has gotten very thin and a lot of fine lines now show (I'm almost 39).  I'm talking a lot of them showing up over the past year.  Injuries heal much slower.  I was bit by mosquitos last year, and it took about four months for them to heal.  Before my injury, a mosquito bite would be healed within two weeks tops.  My bones have broken-down, as I can now run my hand along my shin (Tibia or Fibula?) bone and I feel rivets.  Before the injury, I had a solid, straight bone with no rivets.  I find myself very tired or fatigued to some degree much of the time.  Soft tissue damage in the neck from the accident has up until recently still displayed the sound of crunching, the result of not having enough growth hormone to heal the tissues in a timely manner.

Every day is a battle to make it through the day.  People who have not had a brain injury and a damaged pituitary gland at the same time have no idea how hard life is for people in such a predicament.  It is hard, and it makes you a bit irritable at times,  Unfortunately, most people don't really seem to get it, and they act like you should either function as you always did, or they don't want to hear you talk about your problems,  After living with such hardship, you learn that we should appreciate all that we're given, including health.  So many people worry about frivolous things.  They don't realize how blessed they really are.

Thank God I finally was able to have a doctor that noticed my damaged pituitary, and now I am on track to start growth hormone injections which should restore my brain and return me to full health after suffering for two years. 

I had a closed head injury in 1998, care flight to a Dallas Hospital, X-rayed everything but my head. sustained several injuries but sent home and the nightmare began. A year later an MRI revealed a past closed head injury. From that day on my life changed. Family put off my extremely strange behavior as crazy. Dr's. Depression anything but finding the true cause, so I self medicated, alcohol, drugs both legal and nothing worked but no one really helped and still today 2016 I have to deal with the symptoms and all these years worked in dangerous construction had several concussions but now stay e

My niece of 21 yrs of age has had a  tumor since she was 6 down in the centre of her brain behind her eyes glacoma she has a shunt there for drainage of fluid retained there which worked and she had a productive life up until last yr she had surgery and they had to remove 40% of it to relieve pressure it was life or death situation it effected the puturitary gland  its not working, her thirst is not there, her sodium levels are high due to her fluid intake, she has had multiple seisures and not they have heavily sedated her to stop seisures and to keep low stimulation she fall on the right side where the the new shunt was put in because of enlarged cists formed around the tumor to allow drainage and now there is a small bleed there. shes been sedated for two days now and tried to wake her but she wont they have a air tube in her and now a feeding tube all of this is happening now as I write you she also has short memory loss all of the multiple seisures she had and she had a grandmall seisure that triggered when she fell that put in this terrifying situation. neurologist doctors dont know what to do. she was doing well until all of this happened. There is so more much more to say of this complex situation. The other question if she wakes up will she be in a vegetated state for the rest of her life if she doesnt will she die?

I'm surprised at the figures you give, Dr Bazarian. Most research puts the incidence of longterm hypopituitarism at much higher than that, around 30% after brain injury. http://bit.ly/1aaznvZ and http://bit.ly/1cvWe6w and some papers even higher still. bit.ly/18g66Sd . Diabetes insipidus has also been found to persist in around 6% of TBI patients http://www.ncbi.nlm.nih.gov/pubmed/15579748

Have you explored the possibility that the posterior part of your pituitary gland has been damaged causing diabetes insipidus? This is treatable with anti-diuretic hormone replacement (ADH) and I don't think you need to bother with electrical implants in your bladder.
Hello, I have a son who got a concussion playing D1 basketball. This was 2010. He was treated in Pittsburgh and went through vestibular therapy. He is still dealing with depression, fatigue, has problems doing a full schedule. He was releaseed to return to basketball in 2012 but has yet to be able to resume a full schedule. He attended college as a high school student and is now struggling to stay in school. Could this be hypopituitarism and who do I find to treat it? I have only been able to find anti againg doctors to even aknowledge this exist.
Agood subject. I have a severe TBIs 3 at one time. Front, temporal, cerebellum. Resulted in mild cognitive impairment, short term memory loss, and urine incontency, urge and polyuria. Hx DM type II aodm prior to injury. One contact had acquired diabetes insipidus 2nd TBI blast. Usual TBI sxs for me, extreme faTIGUE since frontal lobe affected believed issue was inhibition and loss of control by frontal lobe to inhibit voiding urgency and urgency which usually results in pre micturation flow and unable to forced avoidance of urine flow initiation. Seen by Urologist who recommend stimulator eletrical implant, and diagnosed neurogenic bladder. Neuro psyche rx'd Provigil to combat fatigue and day time sleepiness which only raised b/p not co-effective for HTN control. Thought polyuria due to elevated blood sugars but wnl 100-110 pre meals w/lantus. Endocrinologist not utilized for eval will try to get a referal to endocrinologist. May have 2ndary injury to pituitary and not realize. Got to GO, GOT TO GO!!!!,,,,,,,,,,,,,,,,,,,,,

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