Prevalence of and Screening for Neuroendocrine Dysfunction Post Mild Traumatic Brain Injury

Scott BlairTraumatic Brain Injury, Webinar


Brain Injury Attorney and Trial Attorney

A couple weeks ago I had the honor of helping host a webinar on screening for pituitary injuries for the Department of Defense and the VA system. I went down to the Seattle VA hospital to meet with Dr. Wilkinson, the gentleman who was speaking to the 200+ military doctors attending this webinar.


While I waited in the lobby for him to come down and meet me, I was struck by all the veterans coming into the VA with what appeared to be all manner of injuries from serving our country. It made it real for me to see these folks first hand versus just reading about them in a news article where we may think about them, but not form a first hand impression of the brave men and women who have sacrificed so much for our country.

As I watched all these heroes come and go from the VA hospital, I wondered how many of them had blast related brain injuries, and how many of them have gone undiagnosed just as many civilians with brain injuries go undiagnosed. I got my answer as soon as Dr. Wilkinson guided me up to his office and showed me all the great screening tools the military is using to diagnose pituitary injuries in veterans with mild or moderate brain injuries. The work he is doing goes against some of the commonly held perceptions that the VA has not done everything it can for our veterans. In fact, they are serving as a model for the private sector who is probably not doing enough to screen for these injuries.

Having handled many pituitary injury cases with civilians who have suffered from brain injuries, I can say first hand it has been tough to find any generalized screening materials used by the private sector to assist physicians, nurse practitioners and their staff in helping detect possible pituitary injuries. A few endocrinologists who actually treat pituitary injuries from brain injuries will use quality of life questionnaires to help detect pituitary dysfunction, but none of the many endocrinologists records that I have seen had any of the incredible materials that the VA system and DOD have adopted to assist veterans returning from Iraq and Afghanistan with possible brain injuries.

Why is that? Well, first, the military doctors treating these conditions probably see a more consistent stream of blast injury victims complaining of TBI (traumatic brain injury) related pituitary problems. Unlike many of the civilian endocrinologists who will typically specialize in the treatment and management of diabetes, and vary rarely even see a patient with these types of complaints, the military doctors see them on a fairly regular basis. The military has learned how important the management of these injuries are, and has taken steps to help screen for such injuries and educate the doctors within the VA system in getting these veterans the vital help they need to get their lives back. Kudos to the VA for being ahead of the curve on this issue!

What I notice when handling pituitary injury cases for my clients is that the insurance companies invariably hire endocrinologists that are originally solicited by a medical exam brokerage that makes doctors available to insurance companies. These endocrinologists that I have deposed so far have little to no experience in handling TBI related pituitary dysfunction. This works for insurance companies because they want to save money by denying that a pituitary injury is related to a TBI. As a result, when insurance carriers retain an endocrinologist who primarily manages diabetes for example, they come to the table with very little of the expertise that a neuro-endocrinologist has. Neuro-endocrinologists who deal with these types of injuries tend to think like the military does-namely that they see the causal relationship between TBI and pituitary problems, while the private endocrinologist who works for insurance companies feel the need to take the “ostrich” approach to the more enlightened approach currently taken by the military. Rather than acknowledging that many, many scientific studies clearly state 30-50% of ALL TBIs causing pituitary problems, they instead try to portray pituitary problems as a very rare occurrence in TBIs, and even then, claim that only moderate to severe TBIs can cause pituitary dysfunction.

It is time for the hired gun endocrinologists who only casually deal with this problem to get educated on the literature, and check out what the military has known for some time-that ALL TBIs can and do cause pituitary problems. Military research and private research nave proven this point. These hired guns would do well to adopt some of the excellent posters and education tools that the VA has made available to its doctors nationwide to help give our veterans a better quality of life after having served out country so fearlessly. These hired guns would also do well to remember the important part of the Hippocratic oath all physicians swear to: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing.” Denying folks the care they need for their pituitary injuries to save an insurance company money is no different than a calloused VA doctor denying a veteran with a pituitary injury care they need to help improve their quality of life.

Let’s learn from the military on this one.


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