Growth Hormone Deficiency Testing and Treatment Following Mild Traumatic Brain Injury

Overview

Journal Sci Rep

Specialty Science

Date 2021 Apr 21

PMID 33879807

Authors

Leah J Mercier

Natalia Kruger

Quynk B Le

Tak S Fung

Gregory A Kline

Chantel T Debert

Affiliations

Soon will be listed here.

Abstract

Pituitary dysfunction, specifically growth hormone (GH) deficiency, can occur following traumatic brain injury. Our objective was to characterize the prevalence of GH deficiency (GHD) testing and response to recombinant human GH (rhGH) treatment in adults with persistent symptoms following mild traumatic brain injury (mTBI) referred for assessment of pituitary dysfunction. A retrospective chart review was conducted of patients seen at an outpatient brain injury clinic with a diagnosis of mTBI and persistent post-concussive symptoms who were referred to endocrinology. Clinical assessments of symptoms were collected. Investigations and results of GHD were collected, including initiation of rhGH treatment and treatment response. Of the 253 patients seen in both brain injury and endocrinology clinics, 97 with mTBI were referred for investigation of pituitary dysfunction and 73 (75%) had dynamic testing for assessment of GHD. Of the 26 individuals diagnosed with GHD, 23 (88%) started rhGH. GH therapy was inconsistently offered based on interpretation of GH dynamic testing results. Of those who started rhGH, 18 (78%) had a useful treatment response. This study suggests that clinical management of these patients is varied, highlighting a need for clear guidelines for the diagnosis and management of GHD following mTBI.

Citing Articles

Concussion and the Autonomic, Immune, and Endocrine Systems: An Introduction to the Field and a Treatment Framework for Persisting Symptoms.

Pertab J, Merkley T, Winiarski H, Cramond K, Cramond A J Pers Med. 2025; 15(1).

PMID: 39852225 PMC: 11766534. DOI: 10.3390/jpm15010033.

References

Giuliano S, Talarico S, Bruno L, Nicoletti F, Ceccotti C, Belfiore A . Growth hormone deficiency and hypopituitarism in adults after complicated mild traumatic brain injury. Endocrine. 2016; 58(1):115-123. DOI: 10.1007/s12020-016-1183-3. View

Popovic V, Pekic S, Pavlovic D, Maric N, Jasovic-Gasic M, Djurovic B . Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress. J Endocrinol Invest. 2005; 27(11):1048-54. DOI: 10.1007/BF03345308. View

Undurti A, Colasurdo E, Sikkema C, Schultz J, Peskind E, Pagulayan K . Chronic Hypopituitarism Associated with Increased Postconcussive Symptoms Is Prevalent after Blast-Induced Mild Traumatic Brain Injury. Front Neurol. 2018; 9:72. PMC: 5825904. DOI: 10.3389/fneur.2018.00072. View

Lithgow K, Chin A, Debert C, Kline G . Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion. BMC Endocr Disord. 2018; 18(1):20. PMC: 5879553. DOI: 10.1186/s12902-018-0247-1. View

Ghigo E, Masel B, Aimaretti G, Leon-Carrion J, Casanueva F, Dominguez-Morales M . Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj. 2005; 19(9):711-24. DOI: 10.1080/02699050400025315. View

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

Ioachimescu A, Hampstead B, Moore A, Burgess E, Phillips L . Growth hormone deficiency after mild combat-related traumatic brain injury. Pituitary. 2014; 18(4):535-41. DOI: 10.1007/s11102-014-0606-5. View

Fann J, Bombardier C, Dikmen S, Esselman P, Warms C, Pelzer E . Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. J Head Trauma Rehabil. 2005; 20(6):501-11. DOI: 10.1097/00001199-200511000-00003. View

High Jr W, Briones-Galang M, Clark J, Gilkison C, Mossberg K, Zgaljardic D . Effect of growth hormone replacement therapy on cognition after traumatic brain injury. J Neurotrauma. 2010; 27(9):1565-75. PMC: 2966848. DOI: 10.1089/neu.2009.1253. View

10.

Hiploylee C, Dufort P, Davis H, Wennberg R, Tartaglia M, Mikulis D . Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. J Neurotrauma. 2016; 34(8):1511-1523. PMC: 5397249. DOI: 10.1089/neu.2016.4677. View

11.

Wright T, Urban R, Durham W, Dillon E, Randolph K, Danesi C . Growth Hormone Alters Brain Morphometry, Connectivity, and Behavior in Subjects with Fatigue after Mild Traumatic Brain Injury. J Neurotrauma. 2019; 37(8):1052-1066. PMC: 7185353. DOI: 10.1089/neu.2019.6690. View

12.

Bavisetty S, Bavisetty S, McArthur D, Dusick J, Wang C, Cohan P . Chronic hypopituitarism after traumatic brain injury: risk assessment and relationship to outcome. Neurosurgery. 2008; 62(5):1080-93. DOI: 10.1227/01.neu.0000325870.60129.6a. View

13.

Kelly D, McArthur D, Levin H, Swimmer S, Dusick J, Cohan P . Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury. J Neurotrauma. 2006; 23(6):928-42. DOI: 10.1089/neu.2006.23.928. View

14.

Schneider H, Kreitschmann-Andermahr I, Ghigo E, Stalla G, Agha A . Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA. 2007; 298(12):1429-38. DOI: 10.1001/jama.298.12.1429. View

15.

Tanriverdi F, Ulutabanca H, Unluhizarci K, Selcuklu A, Casanueva F, Kelestimur F . Three years prospective investigation of anterior pituitary function after traumatic brain injury: a pilot study. Clin Endocrinol (Oxf). 2007; 68(4):573-9. DOI: 10.1111/j.1365-2265.2007.03070.x. View

16.

King N, Crawford S, Wenden F, Moss N, Wade D . The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol. 1995; 242(9):587-92. DOI: 10.1007/BF00868811. View

17.

Yuen K, Biller B, Radovick S, Carmichael J, Jasim S, Pantalone K . AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF GROWTH HORMONE DEFICIENCY IN ADULTS AND PATIENTS TRANSITIONING FROM PEDIATRIC TO ADULT CARE. Endocr Pract. 2019; 25(11):1191-1232. DOI: 10.4158/GL-2019-0405. View

18.

Moreau O, Yollin E, Merlen E, Daveluy W, Rousseaux M . Lasting pituitary hormone deficiency after traumatic brain injury. J Neurotrauma. 2011; 29(1):81-9. DOI: 10.1089/neu.2011.2048. View

19.

Aimaretti G, Ghigo E . Should every patient with traumatic brain injury be referred to an endocrinologist?. Nat Clin Pract Endocrinol Metab. 2007; 3(4):318-9. DOI: 10.1038/ncpendmet0460. View

20.

Nasreddine Z, Phillips N, Bedirian V, Charbonneau S, Whitehead V, Collin I . The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4):695-9. DOI: 10.1111/j.1532-5415.2005.53221.x. View