There are thousands of head injuries in the UK every year.

Every year, more than a million people attend hospital A&E departments in the UK following a head injury. Around 150,000 people will be admitted because of the severity of their injury. [1]

Around a quarter of head injury survivors suffer pituitary damage

Around 20-30% of survivors of traumatic brain suffer from hypopituitarism [2]. Recent research [3, 3a], suggests that most cases remain undiagnosed and untreated. The symptoms include growth failure, delayed or arrested puberty, failure to have periods or reduced libido [4, 4a], difficult in concentrating and fatigue [5] and depression [6]. 10-17% of long-term TBI survivors suffer from impotence [7]. Obviously, cases of delayed puberty and growth failure are diagnosed, but reduced libido, difficulty in concentrating and fatigue, depression and impotence, may never be mentioned to the GP, never mind diagnosed correctly as pituitary damage.

It may not show itself immediately

Symptoms of pituitary damage will not necessarily appear immediately. "Some develop hypopituitarism many years after the initial event." [7b]

It is treatable

This condition is treatable with hormone therapy. "Hypopituitarism [i.e. pituitary damage] is . . treatable after traumatic brain injury." [8]. "Subjects treated with growth hormone experience significant improvements in concentration, memory, depression, anxiety and fatigue." [6]. "It is well known that treatment of hypopituitarism, in particular of growth hormone deficiency, has multiple beneficial effects" [9]. "Testosterone replacement in hypogonadal men has resulted in decreased anger and irritability, and increased libido and energy" [10].

Head injured people are not warned

Head-injured patients are still being discharged from hospital with no inkling of what may lie in wait. Even the National Institute for Clinical Excellence guideline on the treatment of head injury gives no warning in the 'discharge letter' they suggest for use for patients leaving hospital. [11]

Head injured people are at risk

These people are at risk of committing suicide. An Australian study by Simpson and Tate[12] says that out of 178 head injury survivors they monitored, 18% attempted suicide and 35% had clinically significant levels of hopelessness. This is borne out by the Pituitary Foundation's Needs Analysis Report in 2006 [13]. The suicide rate for head-injury survivors is up to four times that of the general population [14].

The government wishes to cut suicides

In 2002 the British Government published its National Suicide Prevention Strategy for England, setting a target of reducing suicides by 20% by the year 2010. However it will take a long time to persuade them to recall all past moderate to severe TBI-survivors for pituitary function testing and appropriate treatment. If you're a head injury survivor, don't wait for the government. If you have any of the symptoms listed, go to your GP and ask to see an endocrinologist.

For more information on the effects of head injury see http://www.headway.org.uk

 

References

[1] Headway website.

[2] Thompson C, Traumatic brain injury-induced hypopituitarism: whom and when to test. Endocrine Abstracts, European Congress of Endocrinology 2007

[3] Agha, A.; Phillips, J.; Thompson, C J., Hypopituitarism following traumatic brain injury (TBI). British Journal of Neurosurgery, Vol 21, issue 2 April 2007 pp. 210-216

[3a] Also Behan, L A; Phillips, J; Thompson, C J; Agha, A; Neuroendocrine Disorders after Traumatic Brain Injury. Journal of Neurology, Neurosurgery and Psychiatry 2008, 79, 763-9

[4] Acerini CL, Tasker RC, Bellone S, Bona G, Thompson CJ, Savage MO. Hypopituitarism in childhood and adolescence following traumatic brain injury; the case for prospective endocrine investigation. European Journal of Endocrinology 2006; 155:663-9

[4a] http://www.eje-online.org/cgi/content/full/155/5/663

[5] Tucker M E, Pituitary dysfunction seen after severe head trauma: screen for neuroendocrine dysfunction. (News). Internal Medicine News 37.19 (Oct 1, 2004) p.1 (2).

[6] Popovic V, Aimaretti G, Casanueva FF, Ghigo E, Hypopituitarism following traumatic brain injury. Growth Hormone IGF Research; 2005 Jun; 15(3): 177-84. Epub 2005 Mar 21.

[7] Agha A, Thompson CJ, High Risk of Hypogonadism after Traumatic Brain Injury: Clinical Implications. Pituitary, Vol 8, Numbers 3-4 December 2005, pp 245-249

[7b] Nachtigall LB, Brain Injury and Pituitary Dysfunction, MGH Neuroendocrine Centre Bulletin 2005

[8] Agha A, Rogers B, Sherlock M, O'Kelly P, Tormey W, Phillips J, Thompson C J. Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury, the Journal of Clinical Endocrinology & Metabolism Vol 89, No 10 4929-4936 2004 by The Endocrine Society.

[9] Baldelli R, Bellone S, Corneli G, Savastio S, Petri A, Bona G, Traumatic Brain Injury-Induced Hypopituitarism in Adolescence, Pituitary, published on line Feb 2006.

[10] Masel, E B, Traumatic Brain Injury Induced Hypopituitarism: The Need and Hope of Rehabilitation, Pituitary 8: 263-266, 2005.

[11] www.nice.org.uk/Guidance/CG176

[12] Simpson G., Tate R., Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychological Medicine 2002 May; 32: 687-98.

[13] Morris M, Jackson S, Needs Analysis Report for Pituitary Foundation, Oct 2006. [This report is not available on line]

[14] Teasdale TW, Engberg AW, Suicide after traumatic brain injury: a population study, J Neurol Neurosurg Psychiatry 2001;71;436-440.

[15] Kelestimur F et al, Chronic Trauma in Sports as a Cause of Hypopituitarism, 2005, Pituitary 8, 259-262

[16] Tanriverdi F, Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism, 2007, Clinical Endocrinology, vol 66:3 pp 360-366, March

[17] Ives J C et al, Hypopituitarism after multiple concussions, a retrospective case study in an adolescent male, 2007 J Athl Training

[18] Dubourg J et al, Sports-related Chronic Repetitive Head Trauma as a Cause of Pituitary Dysfunction, Neurosurg Focus 2011;31(5):e2

Note: The above article requires a subscription. It is available on this linkhttp://www.medscape.com/viewarticle/753229_1. Its conclusions are given below.

Conclusions “Current knowledge clearly supports the proposition that sports, especially combat sports, are a cause of hypopituitarism, particularly isolated GH deficiency. Therefore, the medical community should be aware of this, and participants in sports who were exposed to chronic repetitive TBI should be screened. However, further multicenter and multidisciplinary studies are required to explore the details of pathophysiological mechanisms and to produce accurate prevention recommendations and guidelines on hypopituitarism in sports-related head trauma.”

 

Research