Dr. Brent Masel, Executive Vice President of Medical Affairs, recently published an article in The Clinical Neuropsychologist titled “Neuroendocrine Dysfunction After TBI: A Guide for the Clinical Neuropsychologist.” The review provides neuropsychologists with a comprehensive understanding of neuroendocrine dysfunction following traumatic brain injury (TBI), focusing on post-traumatic hypopituitarism (PTHP) and its implications for cognitive function and rehabilitation.

Why This Matters
For many years, physicians treating individuals with brain injuries have focused primarily on managing symptoms, without the ability to address the underlying causes.
However, when a patient develops a hormonal deficiency following a brain injury, those symptoms may be directly linked to that dysfunction. Treating the root cause can lead to significantly better outcomes. As a physician, it’s both important and exciting to finally have the tools to address these underlying issues, rather than just the symptoms.
Individuals who have experienced a moderate to severe brain injury and are experiencing persistent fatigue or cognitive challenges should be evaluated for potential hormonal dysfunction. Even those with a mild TBI who continue to report these symptoms months later should be tested. The evaluation is straightforward—and there’s every reason to pursue it.

Q: What's the difference between being tired from brain injury and being tired from hormone problems?
Fatigue is a common problem after traumatic brain injury, and hormonal deficiency may be one of the causes of that fatigue. Some patients experience fatigue even when their hormone levels are normal, and the reasons aren't always clear. Anyone experiencing both fatigue and cognitive difficulties after a brain injury should be tested for hormonal deficiency.
About one-third of people with moderate to severe TBIs may have this issue. And among those with mild TBIs who are still symptomatic after eight to twelve months, about a third may also have hormonal deficiencies.

Q: Could hormone issues explain why my mood and thinking haven't improved even with therapy and medication?
Yes, people with hormone deficiencies after TBI often report cognitive issues and fatigue. And when you’re tired, it becomes much harder to maintain a positive mood and concentration.

Q: How long should I wait after my injury before worrying about hormonal dysfunction symptoms that won’t go away?
Endocrinologists typically recommend waiting a year before testing, but doctors in neurorehabilitation typically recommend six to eight months. We differ in timing due to different beliefs that the endocrine system might correct itself over time. However, if symptoms persist, waiting may not be the best approach.

Q: What should I realistically expect from treatment?
Regular doctors can order screening tests, but for more definitive treatment, patients should see an endocrinologist.
Treatment options depend on the hormone involved. Some treatments are as simple as taking a pill. Growth hormone deficiency requires a daily injection with a small needle under the skin, like insulin. However, a once-a-week formulation is now available, and companies are working on a pill form.

Q: How can I tell if my family member's personality changes are from hormones or the brain injury itself?
You can’t. There’s no way to differentiate the two, except to treat the hormonal problem and see what improves.

Q: Are hormone problems more likely or harder to treat in seniors?
No, age doesn’t really make a difference. We all need certain hormone levels, and while those levels change with age, if you’re deficient, you’re deficient. You should still be treated to have those hormones replaced.

Q: Will I ever feel like myself again?
It depends on the severity of your brain injury. For people with hormone deficiencies, replacing those hormones can lead to significant improvements in quality of life. Still, the outcome depends on the injury itself as well.
If someone is being treated and stops, the symptoms almost always return. There are exceptions, but for the most part, the symptoms recur.

Q: My loved one had a 'mild' concussion but still struggles with fatigue and memory 8 months later. Is this normal?
It’s interesting. People with milder TBIs, also known as brain injury-associated fatigue and altered cognition (BIAFAC), often respond well to treatment. If the fatigue is due to growth hormone deficiency following the TBI, it usually improves first, typically within three to four months of treatment. Cognition tends to improve later, around six months.
If the patient stops treatment prematurely, the symptoms tend to return in the same order they originally improved. Fatigue comes back first (around three months after stopping), followed by cognition (around six months later). It’s an intricate process, and it can go away the same way it gets better.