Pituitary Gland and Concussion: What Athletic Trainers Need to Know About Post-Injury Dysfunction

Concussions, classified medically as mild traumatic brain injuries (mTBI), are often treated as transient functional neurological events. Yet some research points to their potential to cause prolonged and sometimes under-recognized physiological disruptions. Among these, pituitary gland dysfunction has emerged as a post-concussive concern—especially relevant for athletic trainers (ATs) who are at the frontline of concussion care in student-athlete populations.

The pituitary gland, often dubbed the "master gland," sits at the base of the brain and regulates critical hormones influencing growth, metabolism, reproductive health, and stress response. Disruption to its function after head trauma can profoundly affect an athlete's physical, cognitive, and emotional recovery. For athletic trainers, understanding this connection is essential to ensuring thorough evaluation and safe return-to-play decisions.

How Concussions Impact the Pituitary Gland

The pituitary gland's vulnerability to injury lies in its anatomical and vascular characteristics. It is suspended by a thin stalk (the infundibulum) and relies on a delicate network of blood vessels originating from the hypothalamus. Even a mild blow to the head can shear these vessels or damage the stalk, impairing hormone secretion.

Studies show that pituitary dysfunction can occur even after mild TBIs. Even mild traumatic brain injuries (mTBIs), such as concussions, may lead to pituitary dysfunction. A retrospective study of adults with mTBI and persistent symptoms found that 26 out of 97 patients (≈27%) had growth hormone deficiency, and 78% of those treated with recombinant GH reported significant symptom improvement.

Real-World Application in Athletic Settings

Consider a high school athlete who sustains a concussion during football season. Initially, symptoms improve within a few weeks, and the athlete returns to class and practice under standard return-to-play protocols. But over the next month, fatigue worsens, academic performance declines, and motivation drops. These signs could suggest lingering neuroendocrine dysfunction.

In such cases, an athletic trainer’s awareness of potential pituitary involvement could prompt referral for hormonal evaluation. This early recognition may uncover treatable hormonal deficits, speeding up recovery and improving quality of life.

Gender-Specific Findings in Female Athletes

Hormonal disruption may manifest differently in female athletes. A study on mild TBI in female athletes found that 12.2% showed pituitary dysfunction: 4.6% had hypopituitarism, and 7.6% had hyperprolactinemia—an excess of the hormone prolactin, which can affect mood and menstrual regularity (source).

Given that signs such as irregular periods, mood changes, or unexplained fatigue may be misattributed to stress or overtraining, athletic trainers must remain vigilant to the possibility of underlying hormonal causes.

Objective Concussion Assessments

Anytime, Anywhere

Sway’s FDA-cleared mobile app provides fast, reliable testing for athletic trainers and healthcare professionals.

Learn More

Mechanisms of Injury and Hormonal Effects

Mechanistically, injury-induced inflammation and vascular shearing appear to drive pituitary dysfunction. Animal studies demonstrate how repeated traumatic brain injuries disrupt the GH/IGF-1 axis, impair vascular integrity, and potentially alter growth during adolescence (source).

In humans, vascular damage to the pituitary-hypothalamic axis can lead to deficiencies in:

Growth hormone (GH): impacting energy, strength, and recovery.
ACTH and cortisol: altering stress response and inflammation regulation.
Gonadotropins (LH/FSH): affecting reproductive health and mood.
Thyroid hormones: influencing metabolism, cognitive clarity, and fatigue levels.
Prolactin and ADH: potentially contributing to emotional lability and fluid balance issues.

Left untreated, these imbalances can delay recovery, increase risk of reinjury, and contribute to mental health challenges.

When and Whom to Screen

Routine endocrine screening is not standard practice post-concussion, particularly in high school and collegiate settings. Yet many experts advocate for targeted screening in cases of prolonged symptoms. A review in Frontiers in Endocrinology suggests that even in mild TBI, hypopituitarism should be considered when symptoms persist beyond the expected window (source).

Athletes experiencing unexplained fatigue, weight changes, depressive symptoms, or irregular menstruation may benefit from referral to an endocrinologist. While not every athlete requires hormonal testing, those with repeated concussions or slow recoveries represent high-priority candidates.

Long-Term Implications and Management

Chronic hormone deficiencies can impair physical performance, mood regulation, and overall wellness. For adolescent athletes, the impact on growth and development adds another layer of concern. Moreover, studies confirm that untreated GHD and adrenal insufficiency can significantly reduce quality of life and complicate return-to-learn and return-to-play timelines (source).

Early intervention can include hormone replacement therapy (HRT), tailored exercise and nutrition plans, and multidisciplinary coordination. Athletic trainers play a vital role in monitoring symptoms, educating families, and collaborating with medical teams.

Supporting Athletic Trainers in Recognition and Referral

For ATs, balancing fast-paced practice environments with comprehensive care is challenging—especially amid budget constraints and time limitations. But recognizing red flags for pituitary dysfunction can profoundly influence outcomes.

Clinical collaboration is key. Athletic trainers should develop pathways for endocrinology referrals and ensure that persistent symptoms are communicated clearly to physicians. Additionally, including neuroendocrine education in concussion management training can empower ATs with the knowledge to advocate effectively for their athletes.

Integrating Hormonal Health into Concussion Protocols

Pituitary dysfunction may be the missing link in cases of prolonged recovery after concussion. As the evidence grows, so too should the awareness among athletic trainers. Recognizing the signs, knowing when to refer, and advocating for comprehensive care are essential steps toward supporting athlete health beyond the initial injury.

Understanding that a concussion isn’t just a brain event—but one with potential ripple effects across the endocrine system—equips athletic trainers to deliver more informed, effective, and compassionate care. Screening, when indicated, should be part of a collaborative post-concussion strategy that puts athlete health and long-term performance at the forefront.

Athletic trainers are essential partners in detecting these hidden disruptions—and helping athletes not just return to play, but return to life at full strength.

Reviewed by Kim Wyand, PT, DPT

Director of Customer Experience, Sway Medical

Dr. Kim Wyand is a licensed physical therapist and concussion education specialist with more than a decade of experience in outpatient orthopedic and neurological rehabilitation. On top of leading the customer experience team, Kim works closely with Sway's research team, ensuring the platform remains grounded in research and consistently aligned with evidence-based best practices. She leads the development of tools and resources that support over 13,000 clinicians and athletic programs in delivering high-quality concussion care.