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Review
. 2023 Jul;40(13-14):1274-1285.
doi: 10.1089/neu.2022.0384. Epub 2023 Mar 21.

Growth Hormone Deficiency Following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services

Tamara L Wexler  1   2 , Kent Reifschneider  3 , Philippe Backeljauw  4 , Javier F Cárdenas  5 , Andrew R Hoffman  6 , Bradley S Miller  7 , Kevin C J Yuen  8
Affiliations
Review

Growth Hormone Deficiency Following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services

Tamara L Wexler et al. J Neurotrauma. 2023 Jul.

Abstract

Abstract Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. This review focuses on GH deficiency (GHD), the most common post-TBI pituitary hormone deficiency. GHD is associated with abnormal body composition, lipid metabolism, bone mineral density, executive brain functions, behavior, and height outcomes in pediatric, adolescent, and transition-age patients. Despite its relatively frequent occurrence, post-TBI GHD has not been well studied in these patients; hence, diagnostic and treatment recommendations are limited. Here, we examine the occurrence and diagnosis of TBI, retrospectively analyze post-TBI hypopituitarism and GHD prevalence rates in pediatric and adolescent patients, and discuss appropriate GHD testing strategies and GH dosage recommendations for these patients. We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.

Keywords: growth hormone deficiency; post-traumatic hypopituitarism; transition of care; traumatic brain injury.

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Conflict of interest statement

TLW has served on advisory boards for Novo Nordisk, Sandoz, and Adrenas. KR has served as an advisor for Endo Pharmaceuticals, Ascendis Pharma, and AbbVie; as a principal investigator for Ascendis Pharma; and as a speaker for Ascendis Pharma and AbbVie. PB has been a consultant for Novo Nordisk, Novartis/Sandoz, Endo Pharmaceuticals, Ascendis Pharma, BioMarin, Tolmar, Cavalry Bioventures, and Ipsen and currently receives research support from Novo Nordisk and Ipsen. JFC has no relevant conflicts of interest to disclose. ARH is a consultant for Novo Nordisk and Ascendis. ARH conducted this research as part of a personal outside consulting arrangement with Novo Nordisk. The research and research results are not, in any way, associated with Stanford University. BSM is a consultant for AbbVie, Ascendis Pharma, BioMarin, Bristol Myers Squibb, EMD Serono, Endo Pharmaceuticals, Novo Nordisk, Orchard Therapeutics, Pfizer, Tolmar, and Vertice and has received research support from Alexion, AbbVie, Aeterna Zentaris, Amgen, Amicus, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health, Pfizer, Prevail Therapeutics, and Sangamo Therapeutics. KCJY received research grants to Barrow Neurological Institute from Ascendis, Corcept, and Amryt; served as an occasional advisory board member for Novo Nordisk, Ascendis, Sandoz, Corcept, Ipsen, Amryt, Strongbridge, Crinetics, and Recordati; and served as an occasional speaker for Recordati, Novo Nordisk, and Corcept.

References

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