New research shows the need for increased hormonal dysfunction screening in concussion patients with persistent symptoms

Two new studies have come out with compelling evidence, further linking hormonal dysfunction with concussions. The root of this connection is the pituitary gland, which releases vital hormones, and is located at the base of the brain. Because this is the only place the brain is held in place by the skull, it experiences the greatest twisting during brain impacts. This twisting is incredibly damaging and is hypothesized to be why up to 35% of patients with persistent TBI have been shown to have a hormonal dysfunction (endocrine dysfunction). 

The most common endocrine dysfunction found in TBI patients is a growth hormone deficiency. This often results in “physical symptoms such as loss of lean muscle mass and strength, increased body fat around the waist, and dyslipidemia. Other common GH deficiency symptoms overlap with the symptoms of “persistent post-concussion”- such as fatigue, poor memory, anxiety, depression, emotional lability, poor attention, and poor concentration.” (Robert Luce, TBI lawyer)

The first study from researchers at the University of Edinburgh, published in the Journal of Neurotrauma, conducted a statistical group analysis of 29 studies examining endocrine dysfunction in TBI patients. With over 2000 patients included, the researchers found that 12 months post-TBI, somewhere from 32-34% of patients with persistent symptoms, had an endocrine dysfunction. This population included all degrees of TBI severity, and while the percentage of endocrine dysfunction was lower for mild TBI (concussion), the correlation persisted. These researchers stated the need for more research on the differences in endocrinology between mild TBI and severe TBI.

 The second study from the University of Arizona and collaborators, published in Frontiers in Neurology, reviewed cases of TBI and endocrine dysfunction in Arizona children. They found that patients with a childhood TBI were three times as likely to be diagnosed with an endocrine dysfunction as a healthy patient. Additionally, the 7-11 age group showed the greatest risk of later developing an endocrine dysfunction. The other potentially at-risk population was girls who were more likely to have an endocrine dysfunction. There is some speculation that this may be due to reporting bias due to an underreporting of symptoms in boys although there is evidence of a sex-bassed difference in concussions risk in adults.

Both of these studies add to the recommendation that providers use preventative screening for endocrine disorders, especially with patients with persistent symptoms.