Traumatic brain injury
Traumatic brain injury (TBI) is the leading cause of disability in those under 40 where it is often particularly catastrophic, leading to long-lasting social and economic burden. Until recently the prevalence of neuroendocrine dysfunction after TBI was not appreciated. It is now clear that 15-30% of TBI patients have hypothalamic-pituitary dysfunction, particularly growth hormone deficiency (GHD), but also ACTH, TSH and gonadotrophin deficiency and Diabetes insipidus. As hypopituitarism, and especially GHD, produces symptoms that can easily be attributed to non-Endocrine effects of TBI, and GH status is not routinely assessed, most cases are undiagnosed and untreated. GH is an important factor in the regulation of brain development and influences cognitive function.
A weekly multidisciplinary TBI clinic based at Charing Cross Hospital provides a follow-up service for TBI patients likely to have persistent impairments. This provides the following services:
Neurology assessment (Dr David Sharp, Consultant Neurologist)
Endocrine assessment (link to TG) to assess, screen and treat hypopituitarism using the dedicated clinical investigation ward at Charing Cross Hospital.
Input from a specialist TBI nurse to co-ordinate care and investigations.
Referral to and assessment by Neuropsychiatrists and specialist Neurologists (e.g. vestibular dysfunction) as needed
Network closely with Community Rehabilitation Teams and Voluntary organisations (e.g. Headway)
For referrals to the joint Endocrine/Neurology Traumatic Brain Injury clinic at Charing Cross Hospital please, fax a referral to: 020 8846 7487 marked for attention of TBI Clinic/Tintin Hunte using the following referral form.
The links of the clinic within the AHSC with Imperial College London and the MRC Clinical Sciences Centre at Hammersmith Hospital also links with ongoing research to (a) Facilitate observational clinical research studies e.g. assessment of epidemiology and natural history of neuropsychological problems post TBI, impact of Endocrine disturbance on outcome; (b) Facilitate neuroimaging research studies in TBI as potential outcome indices e.g. diffusion tensor imaging and functional MRI and (c) Facilitate interventional studies in TBI e.g. benefit of growth hormone replacement.