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. 2016 Sep 1;33(17):1607-13.
doi: 10.1089/neu.2015.4127. Epub 2015 Nov 19.

Detection of Growth Hormone Deficiency in Adults with Chronic Traumatic Brain Injury

Lisa A Kreber  1   2 , Grace S Griesbach  1   3   2 , Mark J Ashley  1   2
Affiliations

Detection of Growth Hormone Deficiency in Adults with Chronic Traumatic Brain Injury

Lisa A Kreber et al. J Neurotrauma. .

Abstract

This study examined the prevalence of growth hormone deficiency (GHD) in patients with traumatic brain injury (TBI) during the post-acute phase of recovery and whether GHD was associated with increased disability, decreased independence, and depression. A secondary objective was to determine the accuracy of insulin-like growth factor-1 (IGF-1) levels in predicting GHD in patients with TBI. Anterior pituitary function was assessed in 235 adult patients with TBI through evaluation of fasting morning hormone levels. GH levels were assessed through provocative testing, specifically the glucagon stimulation test. GHD was diagnosed in a significant number of patients, with 45% falling into the severe GHD (≤3 μg/L) category. IGF-1 levels were not predictive of GHD. Patients with GHD were more disabled and less independent compared with those patients who were not GHD. Those patients with more severe GHD also showed decreased levels of cortisol and testosterone. Symptoms of depression were also more prevalent in this group. In addition, patients with severe GHD had delayed admission to post-acute rehabilitation. This study confirms the high prevalence of GHD in patients with TBI and the necessity to monitor clinical symptoms and perform provocative testing to definitively diagnose GHD.

Keywords: adult brain injury; clinical management of CNS injury; growth hormone deficiency; human studies; hypopituitarism.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Comparison of injury chronicity by growth hormone (GH) category. The severe growth hormone deficiency (sGHD) group took significantly longer to be admitted to post-acute rehabilitation than the moderate growth hormone deficiency (mGHD) group and the no GHD group (nGHD). The mGHD group and the nGHD group were not significantly different from each other. Each value represents the mean ± standard error of the mean, *p < 0.05.
<b>FIG. 2.</b>
FIG. 2.
(a) Comparison of total testosterone levels between the severe growth hormone deficient (sGHD) and the normal growth hormone groups. The sGHD group has significantly lower testosterone levels than the normal growth hormone group. (b) Comparison of morning cortisol levels between the sGHD and the moderate growth hormone deficient (mGHD) groups. The sGHD group has significantly lower cortisol levels than the mGHD group. Each value represents the mean ± standard error of the mean, *p < 0.05.
<b>FIG. 3.</b>
FIG. 3.
(a) Comparison of disability levels between the growth hormone deficiency (GHD) groups and the no growth hormone deficiency (nGHD) groups. The GHD group is made up of the severe and moderate GHD groups. The GHD group had higher scores on the Disability Rating Scale indicating higher levels of disability compared with the nGHD group. (b) Comparison of independence levels between the GHD and the nGHD groups. The GHD group had lower scores on the Independent Living Scale (ILS), indicating lower levels of independence compared with the nGHD group. Each value represents the mean ± standard error of the mean, *p < 0.05.
<b>FIG. 4.</b>
FIG. 4.
Comparison of symptoms of depression between the severe growth hormone deficiency (sGHD), moderate growth hormone deficiency (mGHD), and no growth hormone deficiency (nGHD) groups. There was a significant main effect between groups. Although symptoms of depression were higher in the sGHD group, compared with the other groups, significance was approached (p = 0.056) but not obtained. Each value represents the mean ± standard error of the mean, *p < 0.05.
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References

    1. Faul M., Xu L., Wald M.M., and Coronado V.G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Atlanta, GA
    1. Dams-O'Connor K., Spielman L., Singh A., Gordon W.A., Lingsma H.F., Maas A. I., Manley G.T., Mukherjee P., Okonkwo D.O., Puccio A.M., Schnyer D.M., Valadka A.B., Yue J.K., Yuh E.L.; TRACK–TBI Investigators. (2013). The impact of previous traumatic brain injury on health and functioning: A TRACK-TBI study. J. Neurotrauma 30, 2014–2020 - PMC - PubMed
    1. Selassie A.W., Zaloshnj E.P., Langlois J.A., Miller T., Jones P., and Steiner C. (2008). Incidence of long-term disability following traumatic brain injury hospitalization, United States, 2003. J. Head Trauma Rehabil. 23, 123–131 - PubMed
    1. Bondanelli M., De Marinis L., Ambrosio M.R., Monesi M., Valle D., Zatelli M.C., Fusco A., Bianchi A., Farneti M., and degli Umberti E.C. (2004). Occurrence of pituitary dysfunction following traumatic brain injury. J. Neurotrauma 21, 685–696 - PubMed
    1. Aimaretti G., Ambrosio M.R., Di Somma C., Gasperi M., Cannavò S., Scaroni C., Fusco A., Del Monte P., De Menis E., Faustini-Fustini M., Grimaldi F., Logoluso F., Razzore P., Rovere S., Benvenga S., degli Uberti E.C., De Marinis L., Lombardi G., Mantero F., Martino E., Giordano G., and Ghigo E. (2005). Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J. Clin. Endocrinol. Metab. 90, 6085–6092 - PubMed

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