U.S. DEFENSE DEPARTMENT: THE COMPLICATION OF NEUROENDOCRINE DYSFUNCTION POST TBI

FROM: U.S. DEFENSE CENTERS OF EXCELLENCE

Neuroendocrine Dysfunction: Hidden Complication Following TBI

Posted by Diana Moon, DCoE Public Affairs on March 27, 2013
Health care providers understand that making the correct diagnosis is key to effective treatment and recovery. If you’re a provider, did you know that for your patients with traumatic brain injury (TBI), there’s a fair chance you could overlook a diagnosis of
neuroendocrine dysfunction (NED) post TBI? NED is a condition that can be tricky to diagnose because it has many symptoms in common with other conditions that co-occur with TBI, such as sleep disorders, depression, substance abuse disorder and posttraumatic stress disorder. Health care providers should be aware that because screening for NED is not performed routinely in the acute post-injury period, the dysfunction is under-diagnosed, under-treated and may affect the patient’s rate of recovery.

According to Therese West, subject matter expert with Defense and Veterans Brain Injury Center clinical affairs division, research has noted that an estimated 15 percent of patients with mild TBI experience persistent symptoms, and the incidence of NED in those mild TBI patients ranges from an estimated 16 to 40 percent. Simply put, NED refers to a variety of conditions caused by imbalances in the body's hormone production. There are two areas of the brain responsible for regulating the production of hormones, the hypothalamus and the pituitary gland; both are potentially vulnerable to traumatic brain injury.

Medical guidance to evaluate and treat NED is available to providers in the Neuroendocrine Dysfunction Screening Post Mild Traumatic Brain Injury Clinical Recommendation and Reference Card developed by Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). The tools clarify the indications for post-injury neuroendocrine screening and provide a reference point for screening following traumatic brain injury.

Hard copies of the clinical support tools are available for order through DCoE. To download electronic versions of these tools and other TBI clinical resources, visit the Resources section of the DCoE website. If your patient has symptoms that suggest NED and they don’t resolve after three months, you should consider referring your patient to an endocrinologist.

TOOLKIT HELPS TREAT PATIENTS WITH CO-OCCURRING CONDITIONS

The following excerpt is from the Defense Centers of Excellence website:
Treating patients with mild traumatic brain injury (TBI) can be challenging because TBI symptoms can sometimes resemble a number of psychological health conditions. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) developed Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health to provide guidance on the assessment and management of patients with the co-occurring conditions of concussion, post-traumatic stress disorder, pain, depression and substance use disorder.

The tool kit is a user-friendly, comprehensive clinical guidance tool for primary care providers, featuring evidence-based clinical practice guidelines and recommendations from the Departments of Defense and Veterans Affairs. It provides tips for an effective first appointment; guidance on clinical assessment; treatment recommendations; medication information; and patient education websites.

In January, we wrote about a free mobile application where you can access the tool kit from your iPhone, iPad or Android device. National Center for Telehealth and Technology (T2), a DCoE center, developed the Co-occurring Conditions Toolkit mobile app to give providers immediate access to critical and up-to-date information. Providers can use the app to identify appropriate interventions and timing of services to more effectively meet the needs and improve outcomes for patients who sustained a brain injury. Additional benefits of the app include increased use of evidence-based treatment recommendations, enhanced provider-patient interactions and more appropriate specialty referrals.
Visit the T2 website to see more military mobile apps.

Additionally, DCoE partnered with the U.S. Army to develop the Co-occurring Conditions Toolkit training video to provide an overview and offer instructions on how to apply the tool kit to clinical practice. The video is intended to be an on-the-job training reference and includes characteristics and descriptions of psychological health conditions; step-by-step instructions on using the tool kit; and real patient scenarios.