TBI and the risk of long-term neuro-endocrine disturbance
In cases involving claimants who have suffered a traumatic brain injury, one issue that may arise surrounds possible consequential damage to the hypothalamus and/or pituitary gland, which can lead to neuro-endocrine disturbance.
These small structures at the base of the brain are responsible for regulating hormones and therefore damage to these structures can lead to disruption in the levels of one or more hormones. This can, in turn, negatively impact the body’s ability to maintain a stable internal environment, known as homeostasis.
One possible complication of this is a condition known as hypopituitarism, which is essentially where damage to the pituitary gland leads to a reduction in hormone production.
Symptoms of the condition are varied and can include depression, sexual difficulties, mood swings, fatigue, headaches, muscle weakness, irregular periods, weight gain, dry skin, pale appearance and diabetes insipidus.
The complexity of the condition is compounded by the fact that, not only can many of the symptoms arise as a result of other factors, but there are also currently no guidelines in place for the assessment and treatment of pituitary gland function after brain injury, possibly leading to underdiagnosis of the condition.
If these issues are suspected, then a claimant should receive a referral to an appropriate specialist, such as an endocrinologist, who will be able to run hormone level tests and carry out imaging to look for signs of damage to the hypothalamus or pituitary gland. Specialist input and assessment is clearly essential. Where hypopituitarism is confirmed, hormone replacement therapy may be used to restore hormones to normal levels.
These issues can also lead to a condition known as diabetes insipidus, which is characterised by increased thirst and excessive production of dilute urine. To put it into perspective, while most people make one to three quarts of urine a day, people with diabetes insipidus can make up to 20 quarts.
It's a relatively rare condition, affecting about 1 in 25,000 people worldwide.
There are two main types of diabetes insipidus – cranial and nephrogenic diabetes insipidus. Cranial diabetes insipidus occurs when there is not enough vasopressin in the body to regulate urine production. It's the most common type of diabetes insipidus and can be caused by damage to the hypothalamus or pituitary gland as a result of a brain injury. It can also arise as a result of, for example, a tumour that damages the hypothalamus or pituitary gland, or complications arising from brain or pituitary surgery
As well as the obvious symptoms of thirst and dehydration, others can include dizziness, tiredness, difficulty performing simple mental tasks, nausea and fainting.
Addressing these issues appropriately via endocrinology evidence
In relation to diabetes insipidus, there are two main complications – dehydration, which can lead to dizziness, confusion and irritability, and secondly electrolyte imbalance which can lead to other issues including headaches, fatigue, and muscle pain.
It's essential that medical evidence properly explores the presence of neuro-endocrine disturbance arising as a result of brain injury, and the resulting symptoms – for example depression, fatigue, vision disturbance, dizziness – and how these issues impact the claimant, for example in terms of their ability to work, perform activities of daily living and their care needs.
Options in terms of treatment recommendations should be explored, and a clear opinion in terms of prognosis, if possible at that stage, as well as other longer-term implications and considerations. It's possible that people diagnosed with diabetes insipidus will require long-term monitoring by their GP and/or endocrinologist, including monitoring of medication and/or dietary and lifestyle modifications and that must be appropriately reflected in the claim.
You can find out more about Irwin Mitchell’s expertise in supporting people following serious injury, such as brain injury, at our dedicated personal injury section.