Tags

Type your tag names separated by a space and hit enter

Growth hormone secretion, fatigue and quality of life after childhood traumatic brain injury.

Abstract

CONTEXT

TBI is a recognized cause of hypopituitarism in adults but the prevalence after childhood TBI remains controversial.

OBJECTIVE

To investigate long-term endocrine outcomes and quality of life (PedsQL and QoL-AGHDA [Quality of Life in Adult Growth Hormone Deficiency Assessment]) following childhood TBI.

DESIGN

Prospective study.

METHODS

Participants with moderate/severe TBI (n=31) and controls (n=17). Mean (range) age 19.8±4.2 (11-26), time post TBI 9 (7-11) years. Detailed endocrine evaluation of stimulated (insulin tolerance test [ITT]) and spontaneous GH secretion (overnight profile) was undertaken in the TBI group; QoL and neuroimaging in both groups.

RESULTS

No participant had seizures, short stature, precocious puberty or hypothyroidism. In 6/25 the ITT GH response was below age-defined cut-offs and cortisol <500 nmol/l in 2/25. Mean spontaneous GH secretion was <3.1 mcg/l in 16/22 but peak GH was low only in 1/22 profiles. One patient had abnormal spontaneous and stimulated GH secretion and hypogonadism. Fatigue and depression scores were higher in TBI patients (p=0.011 and p=0.020). Fatigue correlated with measures of spontaneous but not stimulated GH secretion. Overall QoL (PedsQL) did not differ between groups but specific attributes of health state (cognition, memory) were impaired in TBI patients. Pituitary neuroimaging was normal in all participants.

CONCLUSIONS

Fatigue and depression were common 8-10 years post childhood TBI. One individual had GHD (1/22) using rigorous diagnostic criteria. A single ITT potentially over-diagnosed GHD in 25% (6/25) without clear correlation with symptoms underlying the importance of using two diagnostic tests in TBI survivors.

Authors+Show Affiliations

N Daskas, Paediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, United Kingdom of Great Britain and Northern Ireland.P Sharples, Paediatric Neurology, Bristol Royal Hosp Children, Bristol, United Kingdom of Great Britain and Northern Ireland.M Likeman, Radiology, Bristol Royal Hosp Children, Bristol, United Kingdom of Great Britain and Northern Ireland.S Lightman, Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol School of Clinical Science, Bristol, United Kingdom of Great Britain and Northern Ireland.E Crowne, Paediatric Endocrinology, Bristol Royal Hosp Children, Bristol, United Kingdom of Great Britain and Northern Ireland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31319378

Citation

Daskas, Nik, et al. "Growth Hormone Secretion, Fatigue and Quality of Life After Childhood Traumatic Brain Injury." European Journal of Endocrinology, 2019.
Daskas N, Sharples P, Likeman M, et al. Growth hormone secretion, fatigue and quality of life after childhood traumatic brain injury. Eur J Endocrinol. 2019.
Daskas, N., Sharples, P., Likeman, M., Lightman, S., & Crowne, E. (2019). Growth hormone secretion, fatigue and quality of life after childhood traumatic brain injury. European Journal of Endocrinology, doi:10.1530/EJE-19-0166.
Daskas N, et al. Growth Hormone Secretion, Fatigue and Quality of Life After Childhood Traumatic Brain Injury. Eur J Endocrinol. 2019 Jul 1; PubMed PMID: 31319378.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Growth hormone secretion, fatigue and quality of life after childhood traumatic brain injury. AU - Daskas,Nik, AU - Sharples,Peta, AU - Likeman,Marcus, AU - Lightman,Stafford, AU - Crowne,Elizabeth, Y1 - 2019/07/01/ PY - 2019/03/09/received PY - 2019/07/18/accepted PY - 2019/7/19/entrez PY - 2019/7/19/pubmed PY - 2019/7/19/medline JF - European journal of endocrinology JO - Eur. J. Endocrinol. N2 - CONTEXT: TBI is a recognized cause of hypopituitarism in adults but the prevalence after childhood TBI remains controversial. OBJECTIVE: To investigate long-term endocrine outcomes and quality of life (PedsQL and QoL-AGHDA [Quality of Life in Adult Growth Hormone Deficiency Assessment]) following childhood TBI. DESIGN: Prospective study. METHODS: Participants with moderate/severe TBI (n=31) and controls (n=17). Mean (range) age 19.8±4.2 (11-26), time post TBI 9 (7-11) years. Detailed endocrine evaluation of stimulated (insulin tolerance test [ITT]) and spontaneous GH secretion (overnight profile) was undertaken in the TBI group; QoL and neuroimaging in both groups. RESULTS: No participant had seizures, short stature, precocious puberty or hypothyroidism. In 6/25 the ITT GH response was below age-defined cut-offs and cortisol <500 nmol/l in 2/25. Mean spontaneous GH secretion was <3.1 mcg/l in 16/22 but peak GH was low only in 1/22 profiles. One patient had abnormal spontaneous and stimulated GH secretion and hypogonadism. Fatigue and depression scores were higher in TBI patients (p=0.011 and p=0.020). Fatigue correlated with measures of spontaneous but not stimulated GH secretion. Overall QoL (PedsQL) did not differ between groups but specific attributes of health state (cognition, memory) were impaired in TBI patients. Pituitary neuroimaging was normal in all participants. CONCLUSIONS: Fatigue and depression were common 8-10 years post childhood TBI. One individual had GHD (1/22) using rigorous diagnostic criteria. A single ITT potentially over-diagnosed GHD in 25% (6/25) without clear correlation with symptoms underlying the importance of using two diagnostic tests in TBI survivors. SN - 1479-683X UR - https://www.unboundmedicine.com/medline/citation/31319378/Growth_hormone_secretion,_fatigue_and_quality_of_life_after_childhood_traumatic_brain_injury L2 - https://eje.bioscientifica.com/doi/10.1530/EJE-19-0166 DB - PRIME DP - Unbound Medicine ER -