Growth hormone deficiency testing and treatment following mild traumatic brain injury

Leah J Mercier,Tak S Fung,Quynk B Le,Gregory A Kline,Natalia Kruger,Chantel T Debert

doi:10.1038/s41598-021-87385-7

Leah J Mercier, Tak S Fung + Show 4 more

Open Access

https://doi.org/10.1038/s41598-021-87385-7

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Journal: Scientific Reports	Publication Date: Apr 20, 2021
Citations: 3	License type: open-access

Affiliation: University of Calgary, Alberta Health Services

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.

Highlights

Pituitary dysfunction, growth hormone (GH) deficiency, can occur following traumatic brain injury
Of the 37,585 patients seen in the outpatient brain injury clinic (CBIP) and outpatient endocrinology clinics (OECs) during the study period, 253 patients were common between the two services
We found that none of the clinical measures commonly collected in the outpatient brain injury clinic setting are significantly associated with severe GH deficiency (GHD), this may be due in part to the relatively small sample size

Summary

Introduction

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. 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. 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. The current study had two objectives: (1) characterize GHD testing and treatment response in an adult cohort following mTBI; (2) evaluate associations between clinical outcomes and GHD

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