Neurobehavioral And Quality Of Life Changes Associated With Growth Hormone Insufficiency After Traumatic Brain Injury

Background:Traumatic brain injury(TBI)has already became the serious problem threaten public health.Despite increasing effective efforts in prevention,the mortality and morbidity of TBI remains high around the world.In recent studies,the onset growth hormone insufficiency(GHI)is not rare after TBI.The GHI may induce or aggravate neurobehavioral(NB)deficits and reduced quality of life(QOL)after TBI. If the relation of GHI between NB and QOL changes after TBI can be confirmed timely,it is helpful for us to take effective GH replacement therapy that can improve prognosis of TBI patients with GHI.Objective:In the chronic phase after TBI,patients with GHI were compared to those with growth hormone sufficiency(GHS)using NB and QOL outcome measures after undergoing a pituitary function test.This prospective study tested the hypothesis that TBI patients with GHI would exhibit greater NB and QOL impairment than patients with GHS.Provide a rationale for conducting a randomized controlled trial to determine if GH-replacement therapy will alleviate or eliminate NB and QOL deficits in patients with GHI.Methods:By Reviewing Injury Characteristics and GH changes after injure of 43 patients with TBI.We registered age,gender,Glasgow Coma Scale(GCS),pupil changes,ischemic factors and intracranial pressure(ICP)and cerebral perfusion pressure(CPP).At the same time we registered the levels of the GH on 1st,7th,14th, 21st days after hospitalization.Patients at 3 months after TBI underwent pituitary function testing,including a GH-releasing hormone(GHRH)- arginine stimulation test to assess GH-secretory capacity.Using the criteria of 10th percentile levels of peak GH in response to the GHRH-arginine stimulation test in a healthy control cohort,all patients were divided into two groups,patients with GHI and those with GHS.Using Center for Epidemiologic Studies Depression Scale and SF-36 Health Survey test NB and QOL.Two groups were compared using NB and QOL outcome measures.Results:Of 43 patients(mean age,32±18 years,median GCS 7),11 patients was GHI,and 32 patients were GHS at 3 months post-injury.Mean peak GH was 8.1±2.1ng/ml in the GHI group versus 44.7±28.9ng/ml in the GHS group.The two groups were well matched in injury characteristics.At 3 months post injury,patients with GHI had higher rates of at least one marker of depression(P＜0.05),and reduced QOL(by SF-36 Health Survey)in the domains of limitations due to physical health (P＜0.05),energy and fatigue(P＜0.05),emotional well - being(P＜0.05),pain (P＜0.05),and general health(P＜0.05).Chronic GHI develops in approximately 20% of patients with mild,moderate,or severe TBI,and is associated with depression and diminished QOL.Conclusion:This analysis indicates that,following complicated mild,moderate,or severe TBI approximately 20%of patients develop chronic GHI,which in the chronic state after injury is associated with depression and a poor QOL.GHI may induce or aggravate NB deficits and reduced QOL after TBI.