Traumatic Brain Injury and Pituitary Hormones
June 18th, 2009 |
Categories: TBI Adults |
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Pituitary Deficiency and Brain Injury
By Flora Hammond, M.D. and Rhona Shapiro, R.N., M.S.N.
Traumatic brain injury and the pituitary
Pituitary hormone deficiency may result from head trauma or subarachnoid hemorrhage. Two recent studies show that one or more pituitary hormones may be affected by traumatic brain injury or subarachnoid hemorrhage.1,2
Symptoms of hormone deficiency can mimic other effects of a traumatic brain injury, which can prevent suspicion of this disorder. A deficiency of one or more of the hormones regulated by the pituitary gland may have physical and/or psychological effects such as:
- reduced muscle mass
- weakness
- decreased exercise capacity
- fatigue
- irritability
- depression
- impaired memory
- reduced sex drive.
Most patients do not even realize that they have the hormone deficiency until specific laboratory tests for this disorder are performed. However, individuals with a history of a moderate to severe brain injury are more likely to have a pituitary deficiency than those with a mild brain injury.
The likelihood of pituitary damage exists even if the injury occurred years ago and a good rehabilitative outcome has been achieved. The pituitary gland, hypothalamus, and surrounding structures, including their blood supply, may have been injured.
Damage to the pituitary gland causes a condition called hypopituitarism: a loss or reduction in the normal activity of the pituitary gland. Hypopituitarism means that any pituitary hormone can be deficient.
The pituitary is a pea-sized gland at the base of the brain. Pituitary hormones are important because they regulate other hormones from the thyroid, gonads (ovaries and testes), and adrenals (cortisone). Prolactin, oxytocin, and ADH (antidiuretic hormone) may also be effected by brain injury, but the incidence is less common. These hormones are chemical messengers that target vital organs that control vital functions.
Listed below are the hormones produced by the pituitary along with the symptoms commonly seen with a deficiency of each. Diagnostic testing for pituitary hormone deficiency involves blood and urine testing. Hormonal replacement requires monitoring by a physician.
Thyroid stimulating hormone deficiency may cause…
- reduced memory
- slowed metabolism
- reduced energy
- altered mood
- failure to thrive
- slowed growth
- lethargy
- muscle aches
- cold intolerance
- decreased appetite
- dry hair or skin
- numbness or tingling in extremities
Adrenocortical stimulating hormone deficiency may cause…
- weakness
- fatigue
- altered mood
- electrolyte abnormalities
- weight loss
- low or fluctuating blood pressure
- increased body fat
- decreased bone mass
- reduced exercise capacity
Sex hormone deficiency may cause…
- decreased energy
- decreased muscle mass
in males, it may cause…
- decreased sex drive
- shrunken testes
- loss of beard growth
- decreased sperm production
in females, it may cause…
- infertility
- amenorrhea (lack of menstruation)
- loss of female characteristics
Growth hormone deficiency may cause:
- decreased lean body and muscle mass, particularly in the shouldersincreased fat mass, especially around the waist and trunk
- high “bad” cholesterol levels (higher ldl and lower hdl) which may increase risk of stroke and heart diseasedecreased bone density, which may cause osteoporosis
- fatigue, regardless of the amount of sleep.decreased interest in socialization
- a sense of isolation and depression
References
Kelly DF, Gaw Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C. Hypopituitarism following traumatic brain injury and aneurismal subarachnoid hemorrhage: a preliminary report. J Neurosurg.2000; 93: 743-752.
Lieberman SA, Oberoi AL, Gilkison CR, Masel BE, Urban RJ. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab. 1998:83:382-395.
About the Authors
Flora Hammond, M.D.
Dr. Hammond is the Director of Research at the Carolinas Health Care in Charlotte, NC. She also serves as Principal Investigator and Director of CIR’s Traumatic Brain Injury Model System program funded by the National Institute of Disability Rehabilitation and Research. Much of her research on traumatic brain injury has focused on outcome prediction, post-traumatic irritability, depression, relationships, and motor and cognitive recovery over time.
She graduated from the Tulane University School of Medicine in 1990 in New Orleans, LA. Her Physical Medicine and Rehabilitation residency was done at Baylor College of Medicine. Dr. Hammond earned a Brain Injury Fellowship at the Rehabilitation Institute of Michigan in Detroit, Michigan. She is a diplomat of the American Board of Physical Medicine and Rehabilitation. She has served as an invited participant to both the Aspen Conference and Galveston Brain Injury Conference (brain injury think tanks). Her excellence in research, teaching, and administration were acknowledged by her receipt of the 2001 Young Academician Award from the Association of Academic Physiatrists (AAP), and the 2001 AAP Best Faculty Paper Presentation Award.
Rhona Shapiro, RN, MSN
Rhona Shapiro is an experienced nursing educator and clinician. She specializes in adult growth hormone deficiency and in traumatic brain injury and pituitary deficiency.
An experienced educator, she has also served as nursing faculty in a community college setting. A member of the Endocrine Nurses’ Society, Ms Shapiro is an experienced clinician in both acute care and home care settings.
This article is not a substitute for medical advice. Please contact your physician for more information and questions about your condition.
I have a BI since I was five am Sixty six now. I read and I had no idea. Thank you for being on the web so us old folk can still read and learn and share.
This is for Linda Martino regarding her daughter. I sustained a severe TBI in 1997 when I was 27yrs old. Unfortunately, it changes your life forever due to the lack of understanding in society. Just like your daughter, I am totally over doctors. It might not be the thing to help your daughter, but since she is still young, it may help. I got into running. It is an individual challenge for me and exercising every morning is critical for my brain. It is probably more critical for those around me as it completely changes my personality. I pray it helps her.
In August of 2008 I had a head trauma while on vacation. Because at the time I was taking medication for Bipolar and have a history of not tolerating new medications my husband and I didn’t think my symptoms had anything to do with brain trauma.(At the time I had begun to take Abilify) I got out of my husbands truck, struck my head on the door and when getting up got struck again by the closing door. By that night I knew there were serious complications but decided to wait until the weekend was over. My symptoms included dizziness, blurred vision, retrograde amnesia, confusion, and persona change. In two months after striking personality changes my doctor suggested brain imagery tests be done and tests for seizures. We assumed after the injury my symptoms were because of medication complications, it wasn’t. The tests showed no sign of any injury or damage. Though there were serious mental damage done. I didn’t know how to talk to people socially, had difficulty remembering who/what I was, and I was confused about my own life and relationships. Thank goodness after the injury I was on supplementation with natural progesterone cream for my menstruation issues. I used Natural Progesterone Cream three weeks in a row while leaving one week for my period to come for three cycles. My recovery has been very hard, I’ve also had to go to counseling for my long term memory loss. I fully believe it was the progesterone cream that saved me. After all I’ve been through and would not wish anyone to go through it, I will preach to everyone…Natural Progesterone Cream is the reason I’ve gotten my life together. I thank you for this article. Hormones play a very big part in brain injury, they will play a part in how your persona develops after it.
I suggest contacting the Shepherd Center in Atlanta as they are a very well known and respected brain injury rehabilitation program with various specialists. Here is the weblink for their contact page. http://www.shepherd.org/about/contact-us
My dauter sustained a serious head injury when she crashed her motor scooter in dec 2004. She fractured her occipital skull and shattered her mandable bone on both sides. Since then she has had irregular periods, was diagnosed with PCOS, put on 70 lbs in the last 2 years, grown a buffalo hump and is now being looked at for cushing’s disease. I believe this has all been caused by the accident. Is there a specialist in Atlanta that you can recommend?
Dear Angela,
I can understand how worried and scared you may be feeling. I can not answer your question directly about any possible connection between the accident and your pituitary, but I can emphasize that it is very important that you report the history of your accident and your symptoms since then to any and all health care professionals who are examining and treating you. It may be useful to write this down in a one page summary to give to a clinician so you are certain that all the information is communicated.
I was in a car accident one month ago, since the accident I have been passing out frequently and been very tired, blurred vision headaches nausea numbness and tingling in almost all parts of my body, short term memory loss, not being able to handle being cold at all. very weak, and i have lost approx 20 pounds. When the hospital did a ct scan to check if there was any bleeding in my brain they found that my pituitary gland was small, and now i have been referred to a rapid assesment clinic the hostipal, and they have requested that i bring someone for support and as a possible witness, but will not tell me anything else which now has me worried i have been looking up the pituitary gland and causes on the internet now since and was wondering what the chances are that this has something to do with the accident, or something that i have had for a while an the accident has made it worse. I have always suffered from on and off depression and excessive worring but that has also been worse since the accident and was just hoping to get some answers.
hi i am 25 years old, and have been married now for the past 5 years, me and my husband hav been trying for a baby now for 6 years, 5 years ago, i was wrongly diagnosed with polycictic ovary syndrome, i am still undergoing investigations at the womans hospital, as i have not yet concevied, wen i was just 4years old, i ad in a servier rta (road traffic accident). and of the sertain of this i was left with multiple head injuries quite servier, i was left comertised, i have been doing a lot of research in to the pituiatry gland and i am understanding thet head injuaries can bamage this gland, i still have to have me tubes tested, but after reading about head injuries can affect this gland i am 100% sure that there is nothing wrong with my tubes, and that it isthis gland that is causing the problem, of me notgetting pregnant, i was just wondering if there is any one else that has been in the same sittuation, an has had meddication to resolve the problem, and in the result of the meddication have they concieved, am desperate to know of any similar stories, of people, and they have concieved after medication, as i a desperate for a child, i would be honoured just to be blessed with one child, both me and my husband would be so proud to be parents one day
Everyone must take their tbi patient to an endocrinologist and a physiatrist , and make them both aware of this information and ask them to do the appropriate testing to see if it is something that may help the tbi patient get a helping hand in their fight to come back and survive and thrive. Quality of life is so important and I believe this data is something that will give better quality of life for these patients.
Dear Angela,
It sounds like you have sought the expertise of an endocrinologist which is what I would recommend. My only other suggestion is to have your son seen by a developmental pediatrician who may be able to work with the endocrinologist to treat your son.
M. Lash
My son suffered a skull fracture from vacuum extractor at birth. Since then He has seen many doctors to find out why he is not growing. He is almost 4 now and the doctors have still not found an answer to this problem..they have done a stim test for growth hormone but the results showed a mix because the clonidine administered showed one peak level and the arginine adminstered did not stimulate the growth hormone. I am so tired of all these tests and no diagnosis. Any advise?
I truly enjoyed your article. It was extremely educational and useful. I will back to check on upcoming articles
There have been many advances in understanding and treating traumatic brain injury since your injury many years ago. Just recently has the research given evidence that brain trauma may affect hormone production by the pituitary gland. I would encourage you to be seen by a physiatrist which is a physician who has specialized in physical medicine and rehabilitation. It is important to provide both your brain injury history and your endocrine history. I suggest contacting the Brain Injury Association in your state to request a list of outpatient programs for brain injury. An accredited out patient brain injury program will have a physiatrist on staff with this expertise. It would be helpful for a physiatrist to consult with your endrocrinologist and review the records to help sort out what effects may be related to your pituitary levels and what may be cognitive changes due to your brain injury. THis is a complicated question that really requires expertise in both fields.
I suffered a grade 3 head injury in 1986. My pituitary being injured. After being comatosed for more than a month, I awoke and was sent home soon after, with only physical therapy given. The Dr claimed I was “healed” As time has gone on, I have had a child, without having a menstrual cycle, which they said would never happen. I have had a thyroidectome ( thyroid cancer ) and am hypothyroid. My weight gain is out of control. I am depressed, forgetful and experience great pain, during my cycle.
My question is, even though my pituitary levels, etc. come back as productive, does that mean they are necessary normal. Could it be that my hypothalamus could still be messed up? How can I find out? what are my treatment options?
thank you
Shawna Pennington
Damn, awesome website. I actually came across this on Ask Jeeves, and I am happy I did. I will definately be coming back here more often. Wish I could add to the conversation and bring a bit more to the table, but am just absorbing as much info as I can at the moment.
Thank You
Laser Eye Surgery Ireland
Dear Linda,
Your concerns about your daughter are certainly justified given the changes that you have observed. The changes that you list are classic symptoms of brain injury and post concussion syndrome. The potential seriousness and consequences of concussion are too often dismissed because there is usually no loss of consciousness and CT scans and MRI usually do not show any evidence of damage. However, we know that a small percentage of people with concussion will have significant changes and long-term effects that can alter their abilities and functioning. A concussion is a brain injury.
She is also the age where the frontal lobes of the brain typically undergo increased development with her maturation. That is why many teenagers who had earlier brain traumas may show new changes in behavior and difficulty learning as the underlying effects from an earlier injury become evident as the brain continues to develop and school work becomes more challenging.
I strongly recommend having your daughter examined by a physician who specializes in brain injury – a physiatrist (doctor of physical medicine and rehabilitation) or a neurologist with this specialty would have the expertise to consider her history and current symptoms. It would also be wise to have an assessment by a neuropsychologist – this is a licensed psychologist with additional training on brain functioning and brain injury. Again, it is important to select someone with experience with adolescents with brain injury and someone who is accustomed to consulting with school systems.
If you have not already done so, I would have her evaluated for special education services to provide her with additional supports and accommodations in the classroom. Traumatic brain injury is a category under state and federal special education laws. However, many schools have little experience with students with brain injury so it is important for you to be an effective advocate during this process.
She may also qualify for classroom accommodations under a 504 Plan which can be put into place more quickly while you are having her evaluated for special education.
Finally, I would contact the Brain Injury Association in your state to ask for recommendations for specialists in adolescents and brain injury in your area.
I would also be glad to identify some resources for you if you tell me what state you are in so I can match you up. Feel free to call me at the office at 919-556-0300 and we can talk in more detail.
Marilyn Lash
My daughter hit her head sled riding in Jan 2008 at age 13 and was diagnosed with a concussion. Classic symptoms headache, blurred vision, dizziness, short-term memory problems, fatigue – all caused by being exposed to noisy environments, light changes, concentrating, reading, even physical activity. She can’t track with her eyes well (i.e. when the camera pans a landscape or room it gives her sharp pains in her head – she played a game with about 20 bouncing rubber balls and after 20 minutes she slumped against the wall and her eyes were darting and she was a little dazed and then she slept 1.5 hours in the late afternoon. She has had 9 episodes of non-epileptic seizures. They usually begin with a headache then she begins whispering, then staring and then she can only answer by shaking her head yes or no. Her arms and legs begin to shake uncontrollably and her eyes are closed and rolled back and the most recent on 12/22/09 during an in-hospital EEG after about 5 minutes she was not able to answer us at all. This lasted about 20 minutes and then it took another 15 for her to be able to speak. They say she has underlying emotional issues. I say she does not. I say it was brought on by exhaustion and the noisy environments we exposed her to during the afternoon in order to stress her brain and then the noise from the MRI and then she was kept up until 1:30 a.m. waiting to be hooked up to the EEG leads. I didn’t expect to be able to bring this on because she has had only 8 others in 23 months. I think the lack of sleep was the key to pushing her over the edge. She usually gets about 10 hours of sleep. She had the seizure at 2:00 a.m. While she was waiting to be hooked up to the EEG, she watched animal planet at 10 and at 11 to 12 she played cards with her sister and they were laughing and having a good time. Where is the anxiety? She can not attend school because of the volume of work and the noise. She has a limited life. Can you help her? Please give me an idea of what you might do. She has had it with doctors and I just want her to have her life back and I need support and someone who will listen and actively think about what can help her. I think most doctors see her for 15 minutes and never think about her again. Prior to the head injury she had no academic, behavior, emotional or health problems. She was a good student two A’s, two B’s, and maybe one C. One PCS survior I met says correcting hormone levels and vitamin deficiencies can correct or improve some symptoms —- Linda Martino
Very nice information. Thanks for this.
Great site…keep up the good work.
Dear Pat,
I recommend having a physiatrist (a physician with a specialty in physical medicine and rehabilitation) examine your son. I have a very good contact in the Toronto area who I can put you in touch with who would most likely be knowledgeable about specialists closer to your home. I must admit I had to look up New Brunswick to figure out where you are. If you could email me some more details and give me permission to forward your inquiry to her, I would be glad to do so. Marilyn Lash
Our Son suffered a TBI 7 yrs ago; has ongoing problems related with accident and Drs/Surgeons have done all kinds of tests/surgeries, MRI, bone scans, etc. and cannot seem to find problem. Most problem being with pain in feet and legs, low metabolism, muscle/joint pain. If you can help us with a contact at one of the research centres in Canada, please respond, as we have “run out of steam” in finding Drs who are knowledgeble in his unique situation. He has had 4 craniotomies, within 1.5 mths of accident, eye surgery for vision impairment caused from accident, bilateral gastronemic lengthening, many types of physio therapy, etc. Please reply. I will provide lots of details of accident and up to date condition.
Thanks so much for your time, Pat Bourgoin