Many people, especially athletes, experience concussions in their lifetime. As many people are aware concussions can affect anything from your balance to how you sleep at night. One thing that people are not very aware of is how concussions can affect the HPA axis. What researchers focused on was an adolescent male that had received three concussions and now was having major difficulties both during puberty and overall maturity as a teenage male.
In patients who have hypopituitarism caused by concussions, the pituitary can actually be greatly damaged. Scientists first thought that because of the location deep in the brain it would be in a great place to be kept safe but in fact it is the opposite. It's location in the brain makes it perfect for an edema and worse, necrosis. So what do concussions actually do to the pituitary and HPA? When you receive a concussion or TBI your hormones your growth hormones, adrenal hormones, and gonadal hormones decrease and this is in nearly 60% of all TBI's.
Hypopituitarism sometimes doesn't show up until three years post-concussion. This used to be associated with psychological symptoms but lately has been diagnosed as post-concussion syndrome. This could be a reason that hypopituitarism has flown under the radar for so long. The HPA axis is affected because usually the hormones that are most affected are cortisol and ACTH which are the main hormones in the HPA axis and can be fixed by using growth hormone replacement.
Why does this matter? Millions of people suffer from concussions. From mild concussions to severe, hypopituitarism can affect anyone and knowing when something isn't right with your body is important. Doctors need to be especially vigilant of this because in pubescent teens this could really mess up their growth and natural maturity.
References
Ives, J., Alderman, M., & Stred, S. (2007). Hypopituitarism after multiple concussions: a retrospective case study in an adolescent male. Journal Of Athletic Training (National Athletic Trainers' Association), 42(3), 431-439.
Concussions are very scary and very relatable with more and more research being conducted around concussions in the NFL. I knew that concussions could cause damage to the brain, but prior to this blog, I was under the impression that the parts of the brain that was being injured was the areas that can come in direct contact with the skull (temporal, frontal, occipital, etc.). It was very interesting learning that there can also be consequences with the pituitary as well. I feel like this demonstrates the limited knowledge we know about the ways concussions damage and alter our brains, short-term and long-term; this also shows the value and importance of continuous research on concussions since so many of our youth are participating in contact sports.
ReplyDeleteI noticed that you focused on the consequences for prepubescent males, but I was wondering if there are differences across ages as well as differences between the sexes? I could not find many articles in PubMed that I found to be particularly strong in comparing differences between the sexes; the articles that I was finding were mostly focused on young males. This kind of makes sense when thinking that males may be more prone to concussions since they may engage more in the rough, contact sports. However, I think that this presents a concerning gap in our research and knowledge that is more geared towards and favoring the effects in males over females.
Another question that arose, was what would be the effects of hypopituitarism in already sexually mature adults? I would assume that there would be negative effects, but not as seriously as in prepubescent individuals? Again, I struggled finding any good articles in PubMed that addressed these effects in adults; most of the papers I found on adults were focused on changes in memory, attention, etc.
Finally, I was curious to know if you found any research around connecting the repetition and severity of concussions with the severity of the effects? I could not find too much detail about the effects of single concussion events with the focus being on repeated concussions (looked in PubMed database). Overall, I think there is still a lot of improvement that can be done on our knowledge about concussions (although I could have looked in more databases for more information), and it is very interesting to think about what direction our athletics will be moving in as new information is discovered. Will contact sports ever come to a complete end?