Concussions can cause damage to the pituitary gland and/or hypothalamus. This is harmful to the body as these structures are responsible for regulating hormones, thus resulting in hormone imbalance. In fact, early signs of hormone imbalance can appear within the first few hours or days after a concussion.
In addition to the physical impacts of hormone imbalance, many concussion survivors will also suffer from social, emotional, mental, and cognitive effects. Therefore, it is imperative to diagnose and treat hormone imbalance.
What is Hypopituitarism?
Hypopituitarism is a hormone imbalance condition that is a common consequence of concussions. Specifically, hypopituitarism occurs when the front and/or back lobe of the pituitary gland is unable to make hormones, which can cause multiple hypothalamic and pituitary deficiencies.
History of Hypopituitarism
The first reported case of hypopituitarism following a concussion was in 1918. Decades after this, hypopituitarism was considered a rare consequence of concussions. However, in the past 15-20 years, research has shown that hypopituitarism among concussion survivors may be more common than previously believed.
Clinical Symptoms and Signs of Hypopituitarism
As many symptoms of hypopituitarism are non-specific, it is largely under-diagnosed among concussion survivors.
Non-Specific Symptoms of Hypopituitarism:
- fatigue
- cold intolerance
- weakness
- headaches
- visual disturbances
- decreased appetite
- weight loss
- low blood pressure
- abdominal pain
- menstrual irregularities
- decreased libido
- slow growth among children and teenagers
Hypopituitarism can also cause several hormone deficiencies. Each of these deficiencies have associated clinical sign(s):
| Deficiency | Major Clinical Sign(s) |
| Acute Corticotroph Deficiency | weakness, fatigue, nausea, dizziness, vomiting, hypoglycemia, hypotension |
| Chronic Corticotroph Deficiency | pallor, weight loss, anorexia, tiredness, hypoglycemia |
| Thyrotropin Deficiency | weight gain, constipation, tiredness, dry skin, hair loss, cold intolerance, slow mental processes, hoarseness, bradycardia |
| Gonadotropin Deficiency | Women: oligomenorrhea, amenorrhea, infertility, osteoporosis, dyspareunia, loss of libido, premature atherosclerosis
Men: impaired sexual function, loss of libido, decreased bone and muscle mass, hair growth and erythropoiesis |
| Growth Hormone Deficiency | Adults: decreased quality of life, fatigue, increased visceral fat mass, decreased muscle strength and mass, premature atherosclerosis |
| Prolactin Deficiency | Women: inability to breastfeed |
| Anti-Diuretic Hormone Deficiency | nocturia, polyuria, polydipsia |
Risk Factors for Post-Concussion Hypopituitarism
The highest risk factor for the development of post-concussion hypopituitarism is severe concussions.
Other risk factors include:
- old age
- sustaining a car accident after a concussion
- patients with basal skull fractures
- patients with post-traumatic seizures
- patients with diffuse axonal injury
- patients with intracranial haemorrhage and/or petechial brain haemorrhages
- patients with cortical contusions
How is Hypopituitarism Diagnosed?
There are 2 main tests that can be used to diagnose hypopituitarism:
- Blood tests measuring hormone levels in the morning
- Stimulation tests, in which hormone levels are measured after patients take medications that stimulate hormone production
The goal of treating hypopituitarism is to restore normal hormone levels. The treatment is typically long term and lifetime hormone replacement therapy may be necessary for most concussion survivors diagnosed with hypopituitarism.
Written by Dorothy Dinh
Sources
- Kgosidialwa, O., & Agha, A. (2019). Hypopituitarism post traumatic brain injury (TBI): Review. Irish Journal of Medical Science, 188(4), 1201-1206. https://doi.org/10.1007/s11845-019-02007-6
- Kim, S. Y. (2015). Diagnosis and treatment of hypopituitarism. Endocrinology and Metabolism (Seoul), 30(4), 443-455. https://doi.org/10.3803/EnM.2015.30.4.443
- Undurti, A., Colasurdo, E. A., Sikkema, C. L., Schultz, J. S., Peskind, E. R., Pagulayan, K. F., & Wilkinson, C. W. (2018). Chronic hypopituitarism associated with increased postconcussive symptoms is prevalent after blast-induced mild traumatic brain injury. Frontiers in Neurology, 9, 72-72. https://doi.org/10.3389/fneur.2018.00072
- Quinn, M., & Agha, A. (2018). Post-traumatic hypopituitarism-who should be screened, when, and how? Frontiers in Endocrinology (Lausanne), 9, 8-8. https://doi.org/10.3389/fendo.2018.00008
- Richmond, E., & Rogol, A. D. (2014). Traumatic brain injury: Endocrine consequences in children and adults. Endocrine, 45(1), 3-8. https://doi.org/10.1007/s12020-013-0049-1
- Wagner, J., Dusick, J. R., McArthur, D. L., Cohan, P., Wang, C., Swerdloff, R., Boscardin, W. J., & Kelly, D. F. (2010). Acute gonadotroph and somatotroph hormonal suppression after traumatic brain injury. Journal of Neurotrauma, 27(6), 1007-1019. https://doi.org/10.1089/neu.2009.1092