Letters: GPs well placed to pick up effects of brain injury

I was interested to read Dr Simon Fleminger's article on traumatic brain injury (TBI) (GP, 15 May), because I personally encountered the tragic effects of endocrine sequelae after brain injury, when a friend's son committed suicide. A childhood head injury had caused late onset pituitary dysfunction leaving him impotent and prone to depression.

In the process of supporting the family I came across research that shows this is far more common than previously thought and most cases are undiagnosed - tragically, because treatment can be successfully given.

GPs are well placed to pick this up, for example by questioning whether depressed patients have had a head injury and referring them for neurological and endocrine checks. Hormone replacement may be more appropriate than antidepressants.

Neither my GP colleagues nor I had been aware of this, and hope that my friend's loss might help to avoid a further tragedy resulting from hypo-pituitarism secondary to TBI.

Dr Graham Brodie, Derbyshire

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