Frontline Psych with Doc Bender: Neuroendocrine Dysfunction May be Tough to Say, Diagnose

By Dr. James Bender, DCoE psychologist

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

I spent a few days this month in Orlando, Fla., attending the 127th annual American Psychological Association (APA) Convention, which is the largest gathering of psychologists and psychology students in the world. The convention allows health care providers from all areas of specialization in psychology and from research, practice, education and policy to get together for four days to learn about the latest advances in psychology. For the third year, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) subject matter experts presented at this convention to increase psychologists’ knowledge of the unique needs of the military population, including treatment options for psychological health conditions and traumatic brain injury (TBI).

A group of us trained about 25 civilian psychologists as part of a workshop on proven ways to diagnose and treat combat veterans with psychological health and TBI concerns. I focused specifically on TBI, addressing the topics of specialty interventions and classifying and assessing TBI. In my discussion, I highlighted neuroendocrine dysfunction (NED) caused by TBI.

Providers who treat a military population have seen their share of TBI, but they may not be as aware of NED resulting from TBI and may not consider it when assessing and treating a patient with mild TBI. NED can be defined as any condition that is caused by an imbalance of hormones that are produced in the brain. The hypothalamus and pituitary gland are the parts of the brain that produce hormones, and damage to either of these areas can cause NED.

An estimated 15 percent of patients with mild TBI experience persistent symptoms and 15 to 30 percent of that group develop NED. If any of these cases are misdiagnosed, which is easy to do, then some patients have spent a significant amount of time in treatment not getting better and providers have spent a lot of time giving ineffective treatments. Many providers who first learn about NED are surprised to learn about some of the symptoms associated with it including:

■Fatigue

■Insomnia

■Anxiety

■Poor memory

■Lack of concentration

■Frequent mood changes

■Increased abdominal fat mass

■Decreased muscle mass and strength

■Cold intolerance

■Hair loss

Since NED has many symptoms in common with both TBI and other co-occurring conditions like posttraumatic stress disorder, NED can be tricky for providers to diagnose and manage. But if a patient has symptoms that suggest NED that don’t resolve after three months, the provider should consider referring the patient to an endocrinologist. To learn more, DCoE just recently developed clinical support tools that provide medical guidance to evaluate and treat NED. You can download the NED Screening Post Mild TBI Clinical Recommendation and Reference Card or contact DCoE at DCoEProducts@tma.osd.mil to request hard copies.

It’s important for providers to stay abreast of the latest developments in diagnosis and treatments. Organizations like DCoE and APA make this task easier. Visit the Health Professionals section of the DCoE website often for new psychological health and TBI clinical resources.

Thanks for reading.