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.
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.
Authors: Lee E Goldstein; Andrew M Fisher; Chad A Tagge; Xiao-Lei Zhang; Libor Velisek; John A Sullivan; Chirag Upreti; Jonathan M Kracht; Maria Ericsson; Mark W Wojnarowicz; Cezar J Goletiani; Giorgi M Maglakelidze; Noel Casey; Juliet A Moncaster; Olga Minaeva; Robert D Moir; Christopher J Nowinski; Robert A Stern; Robert C Cantu; James Geiling; Jan K Blusztajn; Benjamin L Wolozin; Tsuneya Ikezu; Thor D Stein; Andrew E Budson; Neil W Kowall; David Chargin; Andre Sharon; Sudad Saman; Garth F Hall; William C Moss; Robin O Cleveland; Rudolph E Tanzi; Patric K Stanton; Ann C McKee Journal: Sci Transl Med Date: 2012-05-16 Impact factor: 17.956
Authors: Daniel F Kelly; David L McArthur; Harvey Levin; Shana Swimmer; Joshua R Dusick; Pejman Cohan; Christina Wang; Ronald Swerdloff Journal: J Neurotrauma Date: 2006-06 Impact factor: 5.269
Authors: E Ghigo; B Masel; G Aimaretti; J Léon-Carrión; F F Casanueva; M R Dominguez-Morales; E Elovic; K Perrone; G Stalla; C Thompson; R Urban Journal: Brain Inj Date: 2005-08-20 Impact factor: 2.311
Authors: M Klose; A Juul; L Poulsgaard; M Kosteljanetz; J Brennum; U Feldt-Rasmussen Journal: Clin Endocrinol (Oxf) Date: 2007-05-24 Impact factor: 3.478
Authors: Heidi Terrio; Lisa A Brenner; Brian J Ivins; John M Cho; Katherine Helmick; Karen Schwab; Katherine Scally; Rick Bretthauer; Deborah Warden Journal: J Head Trauma Rehabil Date: 2009 Jan-Feb Impact factor: 2.710
Authors: Charles W Wilkinson; Kathleen F Pagulayan; Eric C Petrie; Cynthia L Mayer; Elizabeth A Colasurdo; Jane B Shofer; Kim L Hart; David Hoff; Matthew A Tarabochia; Elaine R Peskind Journal: Front Neurol Date: 2012-02-07 Impact factor: 4.003
Authors: Jasmeet P Hayes; Meghan E Pierce; Kate E Valerio; Mark W Miller; Bertrand Russell Huber; Catherine B Fortier; Jennifer R Fonda; William Milberg; Regina McGlinchey Journal: Neuropsychopharmacology Date: 2021-08-16 Impact factor: 8.294
Authors: Arundhati Undurti; Elizabeth A Colasurdo; Carl L Sikkema; Jaclyn S Schultz; Elaine R Peskind; Kathleen F Pagulayan; Charles W Wilkinson Journal: Front Neurol Date: 2018-02-19 Impact factor: 4.003