Growth hormone deficiency after TBI: What we’re missing

Warren Collins, a catastrophic injury lawyer, takes a closer look at GHD.

As personal injury solicitors, case managers, and medical experts, we pride ourselves on thoroughness.

Yet one important endocrine complication of traumatic brain injury too often slips through the net: post-traumatic hypopituitarism, particularly growth hormone deficiency (GHD).

The scale of the problem

The incidence is striking. Research indicates that 15-30 per cent of patients with moderate to severe TBI develop some form of pituitary dysfunction, with growth hormone deficiency being the most common, affecting approximately 10-20 per cent of TBI survivors.

Despite these figures, routine endocrine screening remains inconsistent in TBI rehabilitation protocols.

The pituitary gland’s anatomical vulnerability explains this prevalence.

Positioned at the base of the brain and connected by a delicate stalk, it is susceptible to shearing forces during impact, direct trauma, or secondary ischemic injury from raised intracranial pressure.

Understanding growth hormone deficiency

Growth hormone (GH) is not just about height in children.

In adults, it plays crucial roles in maintaining body composition, bone density, cardiovascular health, cognitive function, and psychological wellbeing.

When the pituitary fails to produce adequate GH following trauma, the consequences extend far beyond what we might initially attribute to the brain injury itself.

The diagnostic challenge

Here’s where cases often falter: the symptoms of GHD – fatigue, reduced exercise capacity, increased body fat, decreased muscle mass, low mood, impaired concentration, and social withdrawal – tend to mirror general TBI sequelae.

Without specific testing, GHD can remain completely masked.

Warren Collins

Diagnosis requires biochemical confirmation through stimulation testing, typically an insulin tolerance test or glucagon stimulation test, measuring GH response to provocation.

Random GH levels are essentially useless due to the hormone’s pulsatile secretion pattern. IGF-1 (insulin-like growth factor-1) levels provide a screening tool but lack sufficient sensitivity alone.

Current guidelines recommend endocrine assessment at 12 months post-injury but many patients never receive this evaluation.

Are you considering endocrinology referrals in your cases?

Treatment and its impact

Treatment involves daily subcutaneous growth hormone replacement therapy.

The effects can be transformative: improved energy levels, enhanced cognitive function, better mood regulation, increased muscle mass, reduced adiposity, and improved quality of life scores.

What we are missing in practice

The tragedy lies in misattribution.

When a TBI claimant reports persistent fatigue, cognitive fog, depression, and difficulty returning to physical activities, we document these as direct TBI consequences.

As personal injury lawyers, we routinely instruct rehabilitation experts, neuropsychologists, and occupational therapists.

But without endocrine investigation, we may overlook a treatable condition that is compounding disability.

The financial implications for cases are significant.

Undiagnosed GHD means inadequate treatment plans, undervalued claims for ongoing care needs, and clients whose suffering continues unnecessarily.

Moving forward

We must advocate for comprehensive endocrine screening in moderate-to-severe TBI cases. Instruct endocrinologists alongside neurologists.

Question whether persistent symptoms might have a hormonal component, and ask case managers specifically whether pituitary function has been assessed.

Growth hormone deficiency after TBI isn’t rare but consideration and detection of it often is.

Let’s change that.

About the author

Warren Collins is a solicitor-advocate and partner in the personal injury team at Penningtons Manches Cooper, an international law firm.

He is a regular writer, trainer and commentator on all aspects of catastrophic personal injury law and practice.

Warren acts as chief assessor of the Law Society’s Personal Injury Accreditation Scheme and sits on the editorial board for BABICM Insight Magazine. He has won numerous awards for his work including Catastrophic Injury Lawyer of the Year 2025.

e: warren.collins@penningtonslaw.com