Prevalence of Pituitary Hormone Dysfunction, Metabolic Syndrome, and Impaired Quality of Life in Retired Professional Football Players: A Prospective Study

Abstract

Hypopituitarism is common after moderate and severe traumatic brain injury (TBI). Herein, we address the association between mild TBI (mTBI) and pituitary and metabolic function in retired football players. Retirees 30-65 years of age, with one or more years of National Football League (NFL) play and poor quality of life (QoL) based on Short Form 36 (SF-36) Mental Component Score (MCS) were prospectively enrolled. Pituitary hormonal and metabolic syndrome (MetS) testing was performed. Using a glucagon stimulation test, growth hormone deficiency (GHD) was defined with a standard cut point of 3 ng/mL and with a more stringent body mass index (BMI)-adjusted cut point. Subjects with and without hormonal deficiency (HD) were compared in terms of QoL, International Index of Erectile Function (IIEF) scores, metabolic parameters, and football career data. Of 74 subjects, 6 were excluded because of significant non-football-related TBIs. Of the remaining 68 subjects (mean age, 47.3 -10.2 years; median NFL years, 5; median NFL concussions, 3; mean BMI, 33.8 -6.0), 28 (41.2%) were GHD using a peak GH cutoff of < 3 ng/mL. However, with a BMI-adjusted definition of GHD, 13 of 68 (19.1%) were GHD. Using this BMI-adjusted definition, overall HD was found in 16 (23.5%) subjects: 10 (14.7%) with isolated GHD; 3 (4.4%) with isolated hypogonadism; and 3 (4.4%) with both GHD and hypogonadism. Subjects with HD had lower mean scores on the IIEF survey ( p = 0.016) and trended toward lower scores on the SF-36 MCS ( p = 0.113). MetS was present in 50% of subjects, including 5 of 6 (83%) with hypogonadism, and 29 of 62 (46.8%) without hypogonadism ( p = 0.087). Age, BMI, median years in NFL, games played, number of concussions, and acknowledged use of performance-enhancing steroids were similar between HD and non-HD groups. In summary, in this cohort of retired NFL players with poor QoL, 23.5% had HD, including 19% with GHD (using a BMI-adjusted definition), 9% with hypogonadism, and 50% had MetS. Although the cause of HD is unclear, these results suggest that GHD and hypogonadism may contribute to poor QoL, erectile dysfunction, and MetS in this population. Further study of pituitary function is warranted in athletes sustaining repetitive mTBI.

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: A Neuroendocrine Approach to Patients With Traumatic Brain Injury

“…The estimated burden of long-term disability related to TBI is even greater, affecting approximately 5.3 million individuals in the United States (1). Furthermore, it is likely that TBI is underreported, particularly among patients with mild TBI or those with sportsrelated injuries, many of whom may suffer repeated head trauma (3). In the acute phase, access to health care may be limited in war zones, which may further contribute to underreporting of TBI in these settings.…”

On Treating Athletes with Banned Substances: The Relationship Between Mild Traumatic Brain Injury, Hypopituitarism, and Hormone Replacement Therapy

“…We shall now discuss why exactly TBI-induced hormone deficiency in athletes is cause for concern, and how this concern can be lessened. 3 Nevertheless, in a recent prospective study Kelly et al [44] examined the relationship between hormone dysfunction, concussion, and quality of life in retired NFL players. Surprisingly, they did not find that the amount of NFL games played and the number of reported concussions correlated with an increase in hormone dysfunction.…”

“…For instance, the sample size of NFL players with hormone dysfunction was significantly lower than the sampe size of NFL players without hormone dysfunction. Additionally, it is notoriously difficult to monitor the concussion history and steroid use history in athletes [44].…”

“…The potential benefits of TRT for men with hypogonadism include increased bone density, increased lean muscle mass, improved cognitive function, elevated mood, and increased physical function [43,44]. 5 Although, to our knowledge, there have been no systematic studies involving treatment of TBI-induced hypogonadism with testosterone replacement therapy, the fact that testosterone replacement is recommended as a treatment for all causes of hypogonadism [45] suggests that it could be used to treat symptoms secondary to TBI.…”

Editorial: Orthopaedic Surgeons Should Recommend That Children and Young Adults Not Play Tackle Football

“…While that study had some shortcomings, we believe its main message likely is correct given that the finding persists in more diverse populations of football players as they mature in that sport, through high school [25], college [30] and even at the professional level [4]. Other serious health risks appear in football players at unusually young ages; one study found metabolic syndrome in nearly 20% of collegiate football players [30], and studies on professionals and retired pros found even-more severe health problems [14,24,29], despite those athletes presumably having the best access to trainers, dietary advice, and the ability to focus full-time on physical fitness. Metabolic syndrome, obesity, and carotid plaques simply do not come up in conversations about hockey, soccer, and basketball, and these findings cast additional doubt on the idea that football is an activity that improves the health of young men.…”