When Ian Graham tripped and fell, hitting his head on the kitchen floor in early 2019, he could not have imagined the far-reaching effects it would have on his health.
The former social worker from Liverpool (65) was hospitalized for three weeks after his accident. But the traumatic brain injury he suffered also created a long-term condition that was devastating.
Ian, who is married with two grown children, had been healthy up until that point. But after his fall, he struggled to remember words and suffered from fatigue and apathy. He also developed a shuffling gait.
His wife Anne (66) says his character has also changed: “He had no empathy at all – and he didn’t seem to care about me or my feelings,” she recalls. “I must have cried every day the first year.”
It wasn’t until Ian saw a hormone specialist in 2021 that the cause became clear: he had very low levels of growth hormone, which is essential for many functions in the body, including mood, metabolism and bone density.
Ian, who is married with two grown children, had been healthy up until that point. But after his fall, he struggled to remember words and suffered from fatigue and apathy. He also developed a shuffling gait
While some children are born with growth hormone deficiency (GHD), in adults it is mainly caused by a head injury that damages the pituitary gland, a small bean-shaped gland behind the nose. It regulates the production of most of the body’s essential hormones, including growth hormone.
The pituitary gland can also be damaged by surgery, a tumor, or problems with blood flow to the gland (which can be caused by blood-thinning drugs), according to The Pituitary Foundation, a patient support organization.
In adults, GHD can lead to a variety of symptoms, including loss of strength and endurance, excessive fatigue, anxiety, depression, and decreased bone density.
It can also raise LDL or “bad” cholesterol and other harmful blood fats, as well as directly damage the heart muscle and disrupt glucose metabolism (how carbohydrates are converted into energy by muscle cells), resulting in more fat around the heart’s midline.
This connection to cardiovascular health was important to Ian, as in late 2021 he developed multiple pulmonary embolisms – blood clots in his lungs (considered cardiovascular “events”) that he believed could have been prevented.
“I should have been tested for high cholesterol after being diagnosed with very low growth hormone and should have been on medication,” he says. “I’m now on blood thinners for life.”
It can also raise LDL or “bad” cholesterol and other harmful blood fats, as well as directly damage the heart muscle and disrupt glucose metabolism (how carbohydrates are converted into energy by muscle cells), leading to more fat around the heart’s midline.
For years the role of GHD as a major risk factor for the development of heart disease was overlooked – only last July the British Heart Foundation (BHF) recognized GHD as a cause of high cholesterol.
According to the Society for Endocrinology, there are officially around 6,000 people with adult GHD in England and Wales, although campaigners claim the true number is much higher, but most cases go undiagnosed.
“The consequences of undiagnosed GHD can be so devastating that it can lead to chronic depression and even suicidal thoughts,” says Ashley Grossman, professor of neuroendocrinology at Barts and the London School of Medicine.
Despite its effects, GHD was not recognized as a serious or “clinically relevant” condition until 2005, according to the Journal of Clinical Endocrinology and Metabolism.
As Professor Grossman explains: “Until the late 1980s/early 1990s, we thought that growth hormone was exclusively related to growth. Endocrinologists have known about GHD and heart disease for years, but cardiologists haven’t really thought about it until now.’
Doctors and campaigners have welcomed the news that GHD has now been recognized by the British Heart Foundation as a cause of high cholesterol.
As Professor Grossman explains, this will increase the number of heart disease diagnoses caused by GHD.
Antonio Belli, Professor of Trauma Neurosurgery at the University of Birmingham and an expert on GHD, agrees: “Too many cases of heart disease associated with GHD go undiagnosed. This new BHF recognition can certainly improve the diagnosis rates.’
This “will make a world of difference to adults who suspect there is an underlying, unknown cause for their cardiovascular disease,” adds Joanna Lane.
Two years ago, she founded the Christopher Lane Trust charity to raise awareness of hormonal imbalances, including GHD, after her son took his own life in 2008 aged 31 after falling into severe depression due to impotence.
She believes it is related to damage to his pituitary gland (which also regulates testosterone production) after he fell at the age of seven and was in a coma for two weeks.
The BHF movement, she says, means that people who feel they are “deficient in this important hormone can receive treatment that will save them from suicide or premature death from other causes.”
Joanna has fought to raise awareness of the harm that can result from damage to the pituitary gland and for over a decade has campaigned with other activists at the National Institute for Health and Care Excellence (NICE) for patients with empowering traumatic brain injuries, is warned. that their hormones can be affected.
She eventually had some success, and from March new NICE guidelines will say that these patients should be asked to see their GP when they are discharged from hospital if they have symptoms of hormone deficiency.
This kind of advice may have helped musician John (who wishes to remain anonymous). After suffering a head injury at the age of 20, now 51, John suffered from poor mental health, chronic fatigue and unexplained high cholesterol throughout his adult life.
“I was also often confused and unmotivated,” he recalls. “I had no muscle or sexual function, which was devastating.
“I seemed to develop a new symptom every week.”
But none of the doctors John saw after his head injury ever checked his hormone levels.
When he was 39, he had a heart attack and had a stent implanted to open a blocked artery. But it was another eight years before he was finally diagnosed and treated for GHD. A test result of less than three is consistent with GHD deficiency – John’s was 1.85.
“I cried when I got the results,” he says. “It was an emotional moment because I felt so bad before the test that if I failed, I had already decided to take my own life. Life just wasn’t worth living the way I was back then.’
The symptoms of GHD can be improved by injecting a synthetic form of growth hormone, a treatment that is becoming increasingly available on the NHS. This could potentially reduce the number of patients who develop heart disease.
John, who started growth hormone replacement therapy in November 2020, says that before I started treatment, “I had to cut the laundry in half because I was so tired – now I do it all in one session”.
“My clear thinking has returned and I am less anxious and irritable. I am grateful, but GHD has stolen over two decades of my life that I will never get back. There needs to be better awareness of GHD – especially its links to heart problems.”
Meanwhile, Ian was about to start hormone treatment when he suffered the pulmonary embolism in late 2021.
But now that he is on the daily injections, his symptoms have improved.
“I definitely feel better and my wife and friends say I have improved a lot,” he says.
“I was socially isolated and apathetic and stopped doing all the normal things people do – but I’m more confident in what I say now, although I’m still a bit tired.”
His wife Anne adds: “Since Ian started taking growth hormone injections, he’s a lot more like his old self.
“I also recently noticed that when he walks, he doesn’t shuffle and swing his arm like he used to. I think growth hormone replacement therapy has made a big difference.”
at christopherlanetrust.org.uk
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Crystal Leahy is an author and health journalist who writes for The Fashion Vibes. With a background in health and wellness, Crystal has a passion for helping people live their best lives through healthy habits and lifestyles.
