The pituitary gland is located in the brain behind the bridge of the nose. It is only about the size of a pea – the frontal lobe part of the brain is the biggest part of the pituitary, which controls your cognitive skills. It is therefore very vulnerable and open to damage or dysfunction. You can see how or why, when a traumatic brain injury is sustained, that the pituitary gland can be damaged in any way.
However, damage to the pituitary gland can be overlooked because of brain injury symptoms and any psychological overlay. In the early stages after brain injury, pituitary gland injury is difficult to diagnose as it is normal for a hormonal imbalance to occur. Transient abnormalities in the pituitary function are not uncommon in the acute phase after traumatic brain injury. Chronic and significant abnormalities in the pituitary function in the chronic phase are less common; because they are relatively rare, they are often overlooked.
One symptom commonly associated with pituitary dysfunction is fatigue. This would need to be addressed by a neurologist, but testing for pituitary dysfunction is straightforward, requiring only blood tests for thyroid function, cortisol and LH/FSH. If there are abnormal results then they would need to be referred to an endocrinologist.
Unfortunately, statistics are very much against women as most of the research tests have been carried out on men. This situation results in them being generally dismissed as hormone-related, and it may be that medical treatment options for women are limited – there may also be potential hormonal imbalances from the traumatic brain injury itself.
Fatigue can result from the traumatic brain injury alone, or be associated with other factors, so it is important to bear in mind and explore other causes for fatigue. It is essential that nothing is overlooked and that the injured party is given the best potential treatment options.
Post-traumatic pituitary dysfunction can have major consequences for patients physically, psychologically, and emotionally, and may reduce their quality of life, increase depression and result in a poor rehabilitation outcome.
Symptoms may not even be immediately apparent and may not surface until months or years later. Personal injury lawyers need to be vigilant of this, given the high number of missed diagnoses and this factor being overlooked.
Emma Dryden. Solicitor, Personal Injury department
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