Anterior Pituitary Hormone Replacement In Traumatic Brain Injury
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : August 12, 2009Results First Posted : May 15, 2018Last Update Posted : June 29, 2018|
|Growth Hormone DeficiencyTraumatic Brain Injury||Drug: Recombinant human growth hormone||Phase 4|
|Study Type :|
|Anterior Pituitary Hormone Replacement in Traumatic Brain Injury|
|Study Start Date :|
|recombinant human growth hormone self administered daily for one year||Drug: Recombinant human growth hormone200 mcg daily for two months, followed by 400 mcg daily for two months followed by 600 mcg daily for term of treatment period Other Names:|
Treatment At Cfx: How Can It Help With Hormones
To be clear, we dont directly treat hormone dysregulation at CognitiveFX. You should see an endocrinologist to treat and manage those conditions.
We also cant promise that being treated for post-concussion syndrome will end your hormone dysfunction. However, if the problem behind the hormone dysregulation is neurovascular coupling dysfunction, then restoring that can improve hormone production.
Remember that a large part of hormone production depends on accurate and timely communication between the thalamus, hypothalamus, pituitary gland, and the rest of the body. Some of our patients have been able to reduce or completely go off their hormone medications after treatment at our clinic because this communication system was repaired.
Heres a surprising example: Weve seen a number of patients get pregnant shortly after treatment at our clinic. Some of them were in fertility treatment for years without success. It could just be a coincidence, but its happened enough for us to call them Cognitive FX babies.
Blood Tests For Hormone Dysregulation
Getting a blood test to determine if you have hormone dysregulation seems like it should be a simple, straightforward process. Sometimes it is. Often its not. In fact, it can be fairly complicated.
Resistance From Your Doctor
The first obstacle you might encounter is resistance from your physician to test at all. This seems to defy logic, but it happens. Despite describing your symptoms and wondering if they could be related to a hormone problem, some doctors push back. Maybe they believe your symptoms are completely unrelated to hormones and they wont consider it. Maybe they did one type of test, and that came back normal, so theyve completely discounted the issue. Maybe they think you just like to complain and are seeking attention.
If you continue to have symptoms and your doctor doesnt seem to be listening to you, it might be time to find another doctor. Or at least find another way to get the tests done.
Getting the Right Tests Done
The next issue might be getting the correct tests done. For example, your doctor might be ordering only one test when several are needed. Doctors tend to test only the final hormone level itself, but you might also need to test the levels of other signaling molecules involved in the process.
Lets look at the adrenal glands, for instance. They produce cortisol and aldosterone. Cortisol helps your body respond to stress, and aldosterone helps your body maintain the right balance of water, salt, and potassium.
What Is Normal?
What Hormone Problems Can Happen With Tbi
Someone with TBI can have one or more problems, depending on the injury. Problems that often occur soon after TBI include
Adrenal insufficiency: when the adrenal glands don’t make enough hormones results in fatigue, weight loss, low blood pressure, vomiting, and dehydration. Adrenal insufficiency can be life-threatening if not treated.
Diabetes insipidus: when the pituitary doesn’t make enough ADH results in frequent urination and extreme thirst.
Hyponatremia: when certain hormone problems upset the balance of salt and water in the body can result in headache, fatigue, vomiting, confusion, and convulsions.
Problems that may occur later and their symptoms include
Hypothyroidism : fatigue, constipation, weight gain, irregular menstrual periods, cold intolerance
Hypogonadism : in women, a stop in menstruation and loss of body hair in men, sexual dysfunction, breast enlargement, loss of body hair, and muscle loss
Growth hormone deficiency : in adults, increased fat, loss of muscle and bone, and decreased energy in kids, growth problems
Hyperprolactinemia : irregular menstrual periods, nipple discharge, and erectile dysfunction
What Happens Inside The Brain During A Brain Injury
The brain is an intricate system of blood vessels and neurons which govern thought, movement, emotions, senses, balance, and memory. This soft, vulnerable tissue is surrounded by a protective fluid and the skull.
When something hits the head, the force causes the brain to crash against the skull. Affected parts of the brain compress, stretch or twist.
This forceful impact causes bruising and inflammation. It can damage neurons and disrupt neurovascular coupling , the communication system between neurons and blood vessels in the brain. To function properly, neurons need oxygen. They call for precise amounts of oxygen-rich blood when they need it. When NVC is dysfunctional, injured areas of the brain might not get the resources they need in the right amounts or at the right time. Other areas of the brain might then try to step in and help, but they cant do an efficient job because they have their own tasks to accomplish.
Neurovascular coupling dysfunction is the cause of many post-concussion symptoms. Unfortunately, this type of damage wont show up on a standard magnetic resonance imaging , so if your doctor is trying to connect your symptoms to a brain injury, standard imaging wont show anything wrong. At Cognitive FX, we use functional Neurocognitive Imaging , a special type of MRI to detect neurovascular coupling dysfunction .
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How Can A Dietitian Help
Ensuring adequate and optimal nutrition for health and rehabilitation is crucial. A dietitian working holistically with the wider multidisciplinary team will raise awareness, help with identification and ensure monitoring of hormone deficiencies, resulting in:
- Improving cognition and fatigue levels
- Prevent loss of lean body mass, leading to improved mobility, independence and health
- Optimise bone health to prevent osteopenia and reduce fracture risk
- Weight management
Dr Mark Gordon: Hormones To Heal Traumatic Brain Injuries
Nearly 2 million Americans sustain traumatic brain injuries annually. Conventional medical interventions largely fail to treat the often devastating cognitive, physical, and mental deficits that result. Pioneering specialist Dr. Mark L. Gordon explains how his work with wounded soldiers returning from Iraq and Afghanistan led to a novel, highly effective approach that may heal traumatic brain injury using individually tailored hormone therapy.
Scientifically reviewed by: Dr. Shaylind Benson, ND, in May 2022. Written by: Joseph Carrington.
It can happen without warning: you slip in the shower and hit your head, a car swerves and hits you, a small stroke occurs and suddenly you can’t speak, your mobility is limited, and your world shrinks.
These are real-life examples of the often intractable effects of traumatic brain injury or TBI. And thanks to the groundbreaking work of Dr. Mark L. Gordon and a handful of forward-looking physicians, there’s new hope for the 1.7 million Americans afflicted with this condition.
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The Link To Pituitary Dysfunction
Gordons research strongly suggested that traumatic brain injury often causes pituitary dysfunction, confirming his hunch.41
Research suggests that 50%-76% of traumatic brain injury victims show loss of pituitary neurosteroid function.16,17 Generally, the more severe the original injury, the more profound the deficits. However, neuro-steroid deficiency or insufficiencyin the low-normal rangeis seen even in patients with mild traumatic brain injury.42-45
Although 58% of patients recover normal pituitary function within a year, a shocking 52% develop new pituitary neurosteroid deficiencies a year after injury.46 These deficits include reductions in many pituitary hormones, including those that regulate the thyroid, the adrenal glands , the gonads , and growth hormone.5,17,18,47
The severity of neurosteroid deficiencies correlated strongly with the kinds of symptoms that Gordon was seeing. Patients with growth hormone insufficiency had worse disability scores, greater depression, greater fatigue, and poorer emotional well-being, compared to brain injury patients with normal neurosteroid levels.48,49
Gordons research confirmed that traumatic brain injury victims often had pituitary neurosteroid insufficiencies, especially in growth hormone. And theyre closely associated with persistent neurological, psychological, and emotional deficits tragically common in brain injury survivors.
Evaluation And Treatment Of Anterior Pituitary Deficiencies
Many of the subtle symptoms or signs of an anterior pituitary deficiency such as fatigue or cognitive problems are not always due to a hormonal abnormality. See Table 2 for a list of the symptoms and signs that might mean there is a hormonal system abnormality.
Unfortunately, neuroendocrine clinical practice guidelines for screening patients after a TBI have been inconsistent over many years. New York University Endocrinologist, Dr. Tamara Wexler, specializes in treating patients with TBI and hormonal abnormalities. In a textbook chapter in Brain Injury Medicine, third edition, she recommends screening TBI patients for ACTH and TSH deficiencies in the acute period, treating the deficiencies if present, and then reassessing at 6 and 12 months. She also recommends screening at 3, 6, and 12 months for chronic hormonal deficiencies and treating if a patient is symptomatic. These hormonal evaluations are complicated and require an endocrinologist to design and implement the best protocols for individual patients.
For children with TBI, hormone deficiencies can affect growth and maturation, and pediatric endocrinologists can determine the best screening and treatment protocols.
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How Is Hypopituitarism Treated
In the early stages, hormonal problems can cause a condition called neurogenic diabetes insipidus, which is characterised by increased thirst and excessive production of dilute urine. This is due to a reduction in secretion of a hormone called vasopressin and can be treated by administering desmopressin and replacing lost fluids.
In the later stages, where hypopituitarism is confirmed, treatment may be given. Hormone replacement therapy may be used to restore hormones to normal levels, which should help to 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 more research is needed into the potential long-term benefits of hormone replacement therapy. As with any treatment, you should discuss the pros and cons with your doctor before making any decisions.
Associations Between Clinical Questionnaires And Growth Hormone Deficiency
Testing for homogeneity of regression slope assumptions was performed. For each of the clinical questionnaires, interactions between the covariates and severe GHD were non-significant . After adjusting for age and sex there was no association between severe GHD and measures of symptom burden , depression , cognition or quality of life using the Quality of Life Assessment of Growth Hormone Deficiency in Adults . The estimated marginal mean Montreal Cognitive Assessment score was 25.5±0.7 for those with severe GHD. A cut-off of 26 is used for mild cogntive impairment.
Clinical outcomes and response to dynamic testing. Participants dichotomized as severe GHD or GH sufficient . Symptom burden , depression and quality of life scores were higher in individuals with severe GHD, however this was not statistically significant. Higher Qol-AGHDA scores indicate worse quality of life. Cognition scores were lower in individuals with severe GHD, however this was not statistically significant. GH growth hormone, GHD growth hormone deficiency, MoCA Montreal Cognitive Assessment, PHQ-9 Patient Health Questionnaire-9, RPQ Rivermead Post Concussion Symptoms Questionnaire, QoL-AGHDA Quality of Life Assessment of Growth Hormone Deficiency in Adults.
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Hormone Replacement Therapy Helps Reduce The Side Effects Of Traumatic Brain Injuries In Reno
Hormonal imbalances are chief among the many different side effects of traumatic brain injury. When the body does not create an adequate amount of hormones, vital functions that negatively impact your quality of life are disrupted. In the extreme, hormonal imbalances are be life-threatening. An excellent treatment option, hormone replacement therapy for traumatic brain injury is available in the Reno area.
Each patient treatment with HRT is unique to their type of brain injury and specific hormones imbalances. HRT could be a lifesaving treatment for those with traumatic brain injuries. the Clearfield Medical Group to schedule a consultation with Dr. C. It could significantly improve the quality of your life.
What Is Traumatic Brain Injury
Traumatic brain injury, also called TBI, is sudden damage to the brain. It happens when the head hits something violently or is hit again and again, or when an object goes through the skull and into the brain. Causes include
Violence, such as gunshot wounds, child abuse, or beatings
Injuries from sports or during combat
DID YOU KNOW?
The hypothalamus and the pituitary gland are like orchestra conductors. Their job is to tell other endocrine glands throughout the body to make the hormones that affect and protect every aspect of your health.
Hypothalamus: a part of the brain that controls the release of hormones made by the pituitary gland
Pituitary gland: located at the base of the brain, it’s called the master gland because it makes hormones that tell other glands to make other kinds of hormones
Thyroid gland: found in the neck, it makes thyroid hormones, which control metabolism helps the heart, muscles, and other organs work properly
Adrenal glands: one located on top of each kidney, they make cortisol, which helps the body cope with stress, illness, and injury
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Critical Role Of Hormones In Traumatic Brain Injuryand Disease
It may seem odd that hormonal balances are connected to traumatic brain injury.
However, many studies demonstrate that hypopituitarisma condition in which the pituitary fails to produce normal hormone levelsis relatively common following TBI,29 affecting at least 50 to 76% of victims.30-32 Sometimes hypopituitarism diagnoses are not made for more than 20 years after the injury.33
Brain-injured patients who have a deficiency in growth hormone exhibit greater deficits in attention, executive functioning, memory, and emotion than patients with normal growth hormone levels.34 Growth hormone binds to receptors found in the brain, especially in regions responsible for learning and memory.35,36
The sex hormones, specifically, are also closely related to cognitive function and dysfunction. Sex hormones can function directly as neurotransmitters in the central nervous system.37
At least 16% of long-term TBI survivors develop hypogonadismin which the testes in men or the ovaries in women produce insufficient levels of sex hormones. However, it is estimated that these deficiencies are not identified or treated in most individuals.29
Recent findings,43 confirming 27 prior studies,44 show that estrogen replacement reduces all-cause mortality and increases general well-being in estrogen-deficient women. Progesterone also protects and heals injured brain tissue.45
The Link Between Traumatic Brain Injury And Hormone Deficiency
What Are The Symptoms Of Hypopituitarism
In the early stages after brain injury most people’s hormone levels are severely affected, making diagnosis of hypopituitarism difficult. Later in the recovery process it may become clear that some symptoms are caused by hormonal changes and some rehabilitation units test for this on assessment. However, there are currently no clear guidelines in place for the assessment and treatment of pituitary function after brain injury and more research is needed to determine the scale of the problem.
The effects of pituitary and hypothalamus injury are many and varied because of the huge amount of hormones which can be affected. Some symptoms are similar to the more common effects of brain injury and that is another reason why the problem may be underdiagnosed.
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Evidence From Imaging Studies
Several studies have been published about the possible identification of microstructural abnormalities of the pituitary gland by imaging techniques in patients with TBI-related hypopituitarism. Also in this subset of patients the imaging modality of choice for the evaluation of the pituitary gland was mostly MRI.
No single features were found to predict with high accuracy the presence or the absence of hypopituitarism in patients experiencing TBI. Therefore, in clinical practice the role of imaging in the prediction of post-traumatic hypopituitarism is limited. However, the available evidence is still of significant interest, as it provides information on the possible pathophysiological mechanisms through which post-traumatic hypopituitarism develops.
In this regard, the role of imaging is surely less accurate than that of pathological studies, considering that the deduced evidences about the underlying pathophysiological mechanisms can be only indirect. On the other hand, the clear advantage is that these evidences may be obtained for all patients with TBI, regardless of trauma severity and mortality.
Summary Of Posttraumatic Neuroendocrine Dysfunction
TBI appears to be associated with dysfunction across all of the major domains of neuroendocrine function, although the severity and clinical implications of such dysfunction are highly variable. Despite the frequency of such problems, information is lacking on clear criteria for the diagnosis of deficiencies, their relationship to neurological and neurobehavioral function, expectations regarding time to recovery of neuroendocrine function, and the effects of neuroendocrine interventions on short-term and long-term recovery after TBI. Future efforts, particularly in the area of sex steroid and growth hormone replacement interventions, are needed in view of both basic science and clinical research demonstrating beneficial effects of physiological hormone replacement on various aspects of cognition, mood, and physical functioning. , , Despite the inherent difficulties in performing clinical research in this population, such research is needed to test whether these hormonal replacement strategies may improve the rate of and ultimate level of recovery among persons with TBI.
1 . Bondanelli M, Ambrosio MR, Zatelli MC, et al: Hypopituitarism after traumatic brain injury. Eur J Endocrinol 2005 152:679691
2 . Popovic V, Aimaretti G, Casanueva FF, et al: Hypopituitarism following traumatic brain injury. Growth Horm IGF Res 2005 15:177184
11 . Lee SC, Zasler ND, Kreutzer JS: Male pituitary-gonadal dysfunction following severe traumatic brain injury. Brain Inj 1994 8:571577
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