DCoE Releases Clinical Recommendation, Reference Card to Treat Neuroendocrine Dysfunction

By Corina Notyce, DCoE Strategic Communications

An estimated 1.7 million cases of traumatic brain injury (TBI) occur every year in the United States, according to the Centers for Disease Control and Prevention. More than 244,000 service members have sustained at least one TBI from 2000 through the first quarter of this year, according to the Armed Forces Health Surveillance Center. The majority of both military and civilian TBIs are classified as mild traumatic brain injury (mTBI), and most patients experience complete functional recovery within three months or less of injury. However, some individuals do not recover within this timeframe and may benefit from post-injury neuroendocrine dysfunction (NED) screening.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) developed new clinical recommendations and clinical support tools to guide primary care providers of service members who sustain mTBI. The “Neuroendocrine Dysfunction Screening Post Mild Traumatic Brain Injury Clinical Recommendation and Reference Card” provides medical guidance to evaluate and treat NED. The tools clarify the indications for post-injury neuroendocrine screening and provide a reference point for neuroendocrine screening following traumatic brain injury.

“To our knowledge, there are currently no clinical guidance sources or support tools that present this kind of information to primary care providers,” said Therese West, DCoE subject matter expert on traumatic brain injury. “The goal is to increase primary care providers’ awareness of NED so they consider it along with other more well-known diagnoses such as posttraumatic stress disorder and depression, in service members presenting prolonged symptoms or difficult rehabilitation following a concussion.”

Neuroendocrine dysfunction occurs as a result of direct trauma or biochemical response that interferes with the normal production and regulation of interrelated hormonal processes. The onset of NED can occur any time after sustaining a concussion and up to 36 months post injury. Patients may experience symptoms including fatigue, insomnia, anxiety, poor memory, depression, difficulty concentrating, frequent mood changes and weight gain/weight loss. Since these symptoms are similar to symptoms of other co-occurring conditions such as post-concussive syndrome, sleep disorders, depression or posttraumatic stress disorder, NED can be difficult to diagnose.

“Approximately 15 percent of patients with mild TBI experience persistent symptoms and difficulty in rehabilitation,” said West. “Current literature and expert consensus have identified that from the 15 percent of mild TBI patients whose symptoms don’t resolve in the usual timeframe, an estimated 15 to 30 percent develop NED.”

The NED clinical recommendation and reference card includes information on the co-occurrence of NED and mTBI, onset and manifestation of NED symptoms, and an algorithm to inform providers of when to obtain lab tests and what labs are recommended if NED is suspected.

Additionally, DCoE created education slides to assist providers who have basic knowledge of mTBI but who may require additional information on NED factors.

To request hard copies of the NED Screening Post Mild TBI Clinical Recommendation and Reference Card, contact DCoE at DCoE-Products@tma.osd.mil. To download an electronic version of these tools as well as other TBI clinical resources, visit the Health Professionals section of the DCoE website.