Neuroendocrine Disruptions Following Head Injury

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Yuen KCJ, et al. A consensus on optimization of care in patients with growth hormone deficiency and mild traumatic brain injury. Growth Horm IGF Res. 2022;66:101495. https://doi.org/10.1016/j.ghir.2022.101495. These recent multidisciplinary statements discuss the evaluation and management of growth hormone deficiency in children and adults following mild TBI, highlighting some of the specific barriers in appropriate care for patients.

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Kelly DF, et al. Prevalence of pituitary hormone dysfunction, metabolic syndrome, and impaired quality of life in retired professional football players: a prospective study. J Neurotrauma. 2014;31(13):1161–71. https://doi.org/10.1089/neu.2013.3212. Using a rigorous approach to what might constitute GHD, Kelly and colleagues conducted a prospective study of 68 retired National Football League players (3065yo) with self-reported football-related mild TBI, and with poor quality of life (QOL) scores on a validated questionnaire. They employed both Endocrine Society guidelines (Molitchet al2011) for diagnostic testing (peak GH <3.0 ng/mL on glucagon stimulation testing) and stricter BMI-adjusted criteria based on a separate control group (peak GH <3 if BMI <25 kg/m2; <0.9 if BMI 25–30 kg/m2; <0.5 if BMI >30 kg/m2), determining 41.2% of subjects (28 of 68) were growth hormone-deficient using the standard diagnostic threshold, and 19.1% using their BMI-adjusted cutoffs. This study is important in highlighted the potential importance of GHD, diagnosed by rigorous criteria, in QOL in sports-related TBI. They did not replace GHD in the study.

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