Abstract
The most frequent injury sustained by US service members deployed to Iraq or Afghanistan is mild traumatic brain injuries (mTBI), or concussion, by far most often caused by blast waves from improvised explosive devices or other explosive ordnance. TBI from all causes gives rise to chronic neuroendocrine disorders with an estimated prevalence of 25–50%. The current study expands upon our earlier finding that chronic pituitary gland dysfunction occurs with a similarly high frequency after blast-related concussions. We measured circulating hormone levels and accessed demographic and testing data from two groups of male veterans with hazardous duty experience in Iraq or Afghanistan. Veterans in the mTBI group had experienced one or more blast-related concussion. Members of the deployment control (DC) group encountered similar deployment conditions but had no history of blast-related mTBI. 12 of 39 (31%) of the mTBI participants and 3 of 20 (15%) veterans in the DC group screened positive for one or more neuroendocrine disorders. Positive screens for growth hormone deficiency occurred most often. Analysis of responses on self-report questionnaires revealed main effects of both mTBI and hypopituitarism on postconcussive and posttraumatic stress disorder (PTSD) symptoms. Symptoms associated with pituitary dysfunction overlap considerably with those of PTSD. They include cognitive deficiencies, mood and anxiety disorders, sleep problems, diminished quality of life, deleterious changes in metabolism and body composition, and increased cardiovascular mortality. When such symptoms are due to hypopituitarism, they may be alleviated by hormone replacement. These findings suggest consideration of routine post-deployment neuroendocrine screening of service members and veterans who have experienced blast-related mTBI and are reporting postconcussive symptoms.
Highlights
“Concussions,” a term often used synonymously with “mild traumatic brain injuries”, accounted for 2.8 million emergency room visits or hospitalizations in the US in 2013 [1]
We previously published preliminary data supporting the high prevalence of chronic hypopituitarism in US military veterans deployed to Iraq or Afghanistan who sustained one or more blast-related concussions compared to deployed veterans without blast exposure [27]
Two mild traumatic brain injuries (mTBI) participants screened positive for hypothyroidism and one participant in each group screened positive for hyperprolactinemia
Summary
“Concussions,” a term often used synonymously with “mild traumatic brain injuries” (mTBI), accounted for 2.8 million emergency room visits or hospitalizations in the US in 2013 [1]. 75% of diagnosed TBIs are mTBIs [2]. MTBIs constituted 82.4% of approximately 290,000 military TBIs diagnosed from 2000 to 2013. In both civilian and military populations, many mTBIs are unreported or undiagnosed, and the true incidence has been estimated to be two to five times higher than current reports [6,7,8,9]. A frequent consequence of TBI is chronic hypopituitarism, defined as a deficiency in one or more pituitary hormone axes. We previously published preliminary data supporting the high prevalence of chronic hypopituitarism in US military veterans deployed to Iraq or Afghanistan who sustained one or more blast-related concussions compared to deployed veterans without blast exposure [27]. We have extended our preliminary findings to a larger sample and have examined the effects of chronic hypopituitarism on measures of mood, sleep quality, symptoms of posttraumatic stress disorder (PTSD), and cognitive functioning
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