Did you know that a mild traumatic brain injury (concussion) can injure or disrupt the normal function of the pituitary gland, and that the effects may not show up until months or even years later?
Lawyers who regularly handle traumatic brain injury litigation are certainly familiar with this issue if they are plugged into the brain injury lawyer community, even if they've never personally handled a case involving pituitary dysfunction.
But, surprisingly, a lot of the medical professionals who routinely interact with TBI patients – in particular, mild TBI patients – are not so familiar with this consideration. That seems to be changing in recent years as the research on this issue progresses. But it remains a "blind spot" to many medical professionals such as the family doctor. This makes it even more important for the trial lawyer to have their antenna up when handling a brain injury case.
Doctors who are in the know (meaning they regularly treat TBI patients and are up on the latest literature and research) have little difficulty associating pituitary injury and dysfunction not only with severe head trauma, but as I've seen in my own practice, with the so-called "mild" TBI as well.
Understanding Post-TBI Pituitary Dysfunction
After a TBI, even a so-called "mild" one, the pituitary gland can be damaged and its normal function disrupted. It is not entirely clear why this happens, but the logical candidates include shear forces, vascular injury, or inflammation. When that happens, patients can develop hypopituitarism, including growth hormone deficiency, thyroid dysfunction, adrenal insufficiency, or hypogonadism.
Common Symptoms of Pituitary Dysfunction
The symptoms are often subtle and easily misattributed:
- Persistent fatigue and low energy
- Depression, anxiety, or personality changes
- "Brain fog," memory problems, executive dysfunction
- Reduced libido or hormonal symptoms
- Declining quality of life long after the accident
Critical Implications for TBI Litigation
What makes this particularly important from a litigation perspective is that:
- Pituitary dysfunction is common after TBI, including concussion
- Symptoms can appear long after the initial injury
- Objective endocrine testing can confirm the injury
- Untreated pituitary injuries worsen long-term outcomes and can require lifelong treatment
In one of my recent cases, we worked closely with a board-certified neuroendocrinologist to diagnose and treat severe post-TBI growth hormone deficiency using objective stimulation testing — evidence that simply cannot be faked and is extremely compelling to juries.
This is a nuanced area of TBI medicine and litigation. But when recognized and handled correctly, pituitary injury can explain why a client "never got better" — and it can materially change both case value and outcomes.
When to Consider Pituitary Injury Testing
If you have a brain injury case in which:
- the client plateaued unexpectedly,
- the symptoms don't match the imaging, or
- the defense is minimizing a "mild TBI,"
You should consult with a qualified neuroendocrine expert to consider the possibility of pituitary injury.
And, of course, I'm always happy to talk through whether pituitary injury should be on the radar.
