Concussionology® - Master The Complex
Research 45
mTBI Causes Major Hormone Deficiency
Comment by Dr. Mladenoff
This unique study confirms that there is disturbances in the pituitary stalk as a result of head trauma. They also determined that there neuropsychological differeneces, memory problems and worse performance in the growth hormone deficient group.
The casual observation that is understated is that some of the participants that exhibited growth hormone deficiency had sustained the head trauma as long as 6 months before this study was conducted.
This study confirms that initial evaluation hormone function related to pituitary function is warranted. It is equally prudent to continue to monitor hormonal function for at least 12 months post head trauma.
Growth hormone deficiency after mild combat-related traumatic brain injury
Adriana G Ioachimescu, Benjamin M Hampstead, Anna Moore, Elizabeth Burgess, Lawrence S Phillips
Pituitary 2015, 18 (4): 535-41
OBJECTIVE: Traumatic brain injury (TBI) has been recognized as a cause of growth hormone deficiency (GHD) in civilians. However, comparable data are sparse in veterans who incurred TBI during combat. Our objective was to determine the prevalence of GHD in veterans with a history of combat-related TBI, and its association with cognitive and psychosocial dysfunction.
DESIGN: Single center prospective study.
PATIENTS: Twenty male veterans with mild TBI incurred during combat 8-72 months prior to enrollment.
MEASUREMENTS: GHD was defined by a GH peak <3 μg/L during glucagon stimulation test. Differences in neuropsychological, emotional, and quality of life of the GHD Veterans were described using Cohen's d. Large effect sizes were considered meaningful.
RESULTS: Mean age was 33.7 years (SD 7.8) and all subjects had normal thyroid hormone and cortisol levels. Five (25%) exhibited a subnormal response to glucagon. Sixteen participants (80%) provided sufficient effort for valid neuropsychological assessment (12 GH-sufficient, 4 GHD). There were large effect size differences in self-monitoring during memory testing (d = 1.46) and inhibitory control (d = 0.92), with worse performances in the GHD group. While fatigue and post-traumatic stress disorder were comparable, the GHD group reported more depression (d = 0.80) and lower quality of life (d = 0.64).
CONCLUSIONS: Our study found a 25% prevalence of GHD in veterans with mild TBI as shown by glucagon stimulation. The neuropsychological findings raise the possibility that GHD has adverse effects on executive abilities and mood. Further studies are needed to determine whether GH replacement is an effective treatment in these patients.
Adriana G Ioachimescu, Benjamin M Hampstead, Anna Moore, Elizabeth Burgess, Lawrence S Phillips
Pituitary 2015, 18 (4): 535-41
OBJECTIVE: Traumatic brain injury (TBI) has been recognized as a cause of growth hormone deficiency (GHD) in civilians. However, comparable data are sparse in veterans who incurred TBI during combat. Our objective was to determine the prevalence of GHD in veterans with a history of combat-related TBI, and its association with cognitive and psychosocial dysfunction.
DESIGN: Single center prospective study.
PATIENTS: Twenty male veterans with mild TBI incurred during combat 8-72 months prior to enrollment.
MEASUREMENTS: GHD was defined by a GH peak <3 μg/L during glucagon stimulation test. Differences in neuropsychological, emotional, and quality of life of the GHD Veterans were described using Cohen's d. Large effect sizes were considered meaningful.
RESULTS: Mean age was 33.7 years (SD 7.8) and all subjects had normal thyroid hormone and cortisol levels. Five (25%) exhibited a subnormal response to glucagon. Sixteen participants (80%) provided sufficient effort for valid neuropsychological assessment (12 GH-sufficient, 4 GHD). There were large effect size differences in self-monitoring during memory testing (d = 1.46) and inhibitory control (d = 0.92), with worse performances in the GHD group. While fatigue and post-traumatic stress disorder were comparable, the GHD group reported more depression (d = 0.80) and lower quality of life (d = 0.64).
CONCLUSIONS: Our study found a 25% prevalence of GHD in veterans with mild TBI as shown by glucagon stimulation. The neuropsychological findings raise the possibility that GHD has adverse effects on executive abilities and mood. Further studies are needed to determine whether GH replacement is an effective treatment in these patients.