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Neuroendocrine Dysfunction: Hidden Complication Following TBI

Special clinic treats Soldiers with special injuries
U.S. Army photo by Sgt. Brent C. Powell

Health care providers understand that making the correct diagnosis is key to effective treatment and recovery. If you’re a provider, did you know that for your patients with traumatic brain injury (TBI), there’s a fair chance you could overlook a diagnosis of neuroendocrine dysfunction (NED) post TBI? NED is a condition that can be tricky to diagnose because it has many symptoms in common with other conditions that co-occur with TBI, such as sleep disorders, depression, substance abuse disorder and posttraumatic stress disorder. Health care providers should be aware that because screening for NED is not performed routinely in the acute post-injury period, the dysfunction is under-diagnosed, under-treated and may affect the patient’s rate of recovery.

According to Therese West, subject matter expert with Defense and Veterans Brain Injury Center clinical affairs division, research has noted that an estimated 15 percent of patients with mild TBI experience persistent symptoms, and the incidence of NED in those mild TBI patients ranges from an estimated 16 to 40 percent. Simply put, NED refers to a variety of conditions caused by imbalances in the body's hormone production. There are two areas of the brain responsible for regulating the production of hormones, the hypothalamus and the pituitary gland; both are potentially vulnerable to traumatic brain injury.

Medical guidance to evaluate and treat NED is available to providers in the Neuroendocrine Dysfunction Screening Post Mild Traumatic Brain Injury Clinical Recommendation and Reference Card developed by Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). The tools clarify the indications for post-injury neuroendocrine screening and provide a reference point for screening following traumatic brain injury.

Hard copies of the clinical support tools are available for order through DCoE. To download electronic versions of these tools and other TBI clinical resources, visit the Resources section of the DCoE website. If your patient has symptoms that suggest NED and they don’t resolve after three months, you should consider referring your patient to an endocrinologist.

Comments (3)

  • Strictly speaking, caffeine use by itself disrupts the normal chemical function of the neurvous system and brain.  I think that you should recommend that caffeine should not be consumed by anyone, except to relieve caffeine withdrawl headache.  Not considering the disruption to the normal chemical function of the neurvous system and disruption to the normal function of the kidneys, circulatory system, and digestive system, caffeine should not be consumed simply because the wearing off of the caffeine "buzz" makes people feel physically uncomfortable and so they move on to alchohol and other drugs to feel better.  Being addicted to caffeine is a pathetic way to ruin your health, and there is no reason why anyone should use caffeine.
  • @John, Thanks for your comment.
  • You guys saved my life. I was a reserve medic in the Canadian Forces and got injured. Because of your research and treatment guidelines I got a hormone panel done and had low T and resting cortisol over 12. After looking at the symptoms we did a specific panel for anterior pituitary hormones. They were almost nonexistent. Started supplementing the T and HGH and keeping the levels well within biological norms.
    In 9 months I have lost 34 pounds of fat and regained 23 pounds of muscle. If I had been treated in a timely fashion I would not have had to release. I dug my old pants out of the basement from before I got injured. They fit again and I feel like I did before the injury.
    Great work.

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This page was last updated on: September 14, 2017.