Hypogonadism is associated with lower functional performance during inpatient rehabilitation following hypoxic ischemic encephalopathy

Abstract

Neuroendocrine dysfunction, including hypogonadism, is a frequent complication after traumatic brain injury (TBI). Hypogonadism has been associated with worse functional performance after TBI. The prevalence of hypogonadism and its relationship to functional status after hypoxic ischemic encephalopathy (HIE) has not been previously reported. This study aimed to determine if hypogonadism is also negatively associated with functional performance during inpatient rehabilitation following HIE. Records were reviewed from male patients sequentially admitted for inpatient rehabilitation following HIE over a three-year period at an academic inpatient rehabilitation facility in the United States. Demographic, diagnostic, Functional Independence Measure (FIM) data, and serum endocrine results were collected. Linear regression analysis was performed to investigate the association between hormone values and functional status with a focus on Testosterone (T) function. Twenty-nine male subjects were admitted with HIE during the target time frame. Subjects had a mean age of 37.6 years. Twenty subjects had T levels drawn on admission to rehabilitation; of these, five (25%) had levels below the normal range (2.0–8.0 ng/mL). Lower T levels were associated with worse admission total FIM ( P = 0.001), motor FIM ( P = 0.004) and cognitive FIM scores ( P = 0.003). Low T levels were also associated with worse discharge total FIM ( P = 0.04) and cognitive FIM scores ( P = 0.05) and a trend towards lower discharge motor FIM scores ( P = 0.06). The prevalence of hypogonadism in this population of HIE subjects was 25%, similar to that seen in studies of subjects with TBI. Hypogonadism was negatively associated with a lower functional status across domains. This relationship is similar to that seen in the traumatic brain injury population. Impaired hormone function should be considered clinically following HIE and warrants further investigation.