Research Reports - Persistent hypogonadotropic hypogonadism in men after traumatic brain injury: Temporal hormone profiles and outcome prediction
J Head Trauma Rehabil. 2016 Jul-Aug;31(4):277-87. doi:
Barton DJ(1), Kumar RG, McCullough EH, Galang G, Arenth PM, Berga SL, Wagner AK.
OBJECTIVE: To (1) examine relationships between persistent hypogonadotropic
hypogonadism (PHH) and long-term outcomes after severe traumatic brain injury
(TBI); and (2) determine whether subacute testosterone levels can predict PHH.
SETTING: Level 1 trauma center at a university hospital.
PARTICIPANTS: Consecutive sample of men with severe TBI between 2004 and 2009.
DESIGN: Prospective cohort study.
MAIN MEASURES: Post-TBI blood samples were collected during week 1, every 2 weeks
until 26 weeks, and at 52 weeks. Serum hormone levels were measured, and
individuals were designated as having PHH if 50% or more of samples met criteria
for hypogonadotropic hypogonadism. At 6 and 12 months postinjury, we assessed
global outcome, disability, functional cognition, depression, and quality of
RESULTS: We recruited 78 men; median (interquartile range) age was 28.5 (22-42)
years. Thirty-four patients (44%) had PHH during the first year postinjury.
Multivariable regression, controlling for age, demonstrated PHH status predicted
worse global outcome scores, more disability, and reduced functional cognition at
6 and 12 months post-TBI. Two-step testosterone screening for PHH at 12 to 16
weeks postinjury yielded a sensitivity of 79% and specificity of 100%.
CONCLUSION: PHH status in men predicts poor outcome after severe TBI, and PHH can
accurately be predicted at 12 to 16 weeks.