Hormone Therapy

Head Injury and Hormonal Dysfunction

Traumatic brain injury, also known as TBI, can damage the hypothalamus and pituitary gland. Located at the base of the brain, they regulate our hormones and can release insufficient or increased hormones when damaged, so disrupting the body's ability to maintain a stable internal environment.

When pituitary gland damage causes reduced hormone production, the condition is called hypopituitarism and was first reported almost 100 years ago. Originally thought to be a rare occurrence, recent research on adult survivors of severe brain injury, now report the incidence of pituitary hormone deficiencies to be between 23% and 69%.

Symptoms and assessment

Most people's hormone levels are severely affected in the early stages after traumatic brain injury, even if the pituitary is undamaged. This makes pituitary damage hard to identify and whilst later in the recovery process it may become clear that some symptoms are caused by hormonal changes which can be tested, there are currently no clear guidelines for the assessment and treatment of pituitary function after brain injury.

The effects of pituitary and hypothalamus injury vary because of the different hormones which can be affected and some symptoms are also similar to the more common effects of brain injury, which is another reason why the problem is not easily diagnosed.

Overlapping symptoms are:
• Depression
• Impotence and altered sex drive
• Mood swings
• Fatigue
• Headaches
• Visual disturbance

Other symptoms include:
• Muscle weakness
• Reduced body hair
• Irregular periods/loss of normal menstrual function
• Reduced fertility
• Weight gain
• Increased cold sensitivity
• Constipation
• Dry skin
• Pale appearance
• Low blood pressure/dizziness
• Diabetes insipidus

Whilst each symptom may be caused by a change in the level of a particular hormone produced in the pituitary gland, there are many possible causes of all of these symptoms, so a thorough assessment is needed before a firm diagnosis can be made.

Treatment

Early on, hormonal problems can cause neurogenic diabetes insipidus, which is characterised by increased thirst and excessive production of dilute urine. This is due to a reduction in a hormone called vasopressin (anti-diuretic hormone) and is treated by administering desmopressin and replacing lost fluids.

In the later stages, if hypopituitarism is confirmed, hormone replacement therapy may be used to restore normal hormone levels, to help manage the symptoms. There are different treatments available, depending on the particular hormones involved and the nature and extent of the symptoms.

The assessment and treatment of hypopituitarism after brain injury is a complex process and as with any treatment, you should discuss the pros and cons with your doctor before making any decisions.

Further information

The full extent of hypopituitarism after brain injury is unknown, whilst it seems to occur mainly after severe brain injury some studies have shown that pituitary gland damage may also occur after apparently minor head injuries. However many of the symptoms can be caused by damage elsewhere in the brain, and if this is the case treatment for pituitary dysfunction will not work.

If you suspect symptoms of hypopituitarism, or any other hormonal condition, you should speak to your GP who, if they feel it appropriate, may refer you to an endocrinologist who can run a variety of hormone level tests and even a scan, to look for damage to the hypothalamus or pituitary gland.