Research Reports - Hypothalamic-pituitary dysfunction following traumatic brain injury affects functional improvement during acute inpatient rehabilitation

J Head Trauma Rehabil. 2012 May 18

Rosario ER, Aqeel R, Brown MA, Sanchez G, Moore C, Patterson D.

OBJECTIVE:: To evaluate the occurrence of hypothalamic-pituitary dysfunction
following a traumatic brain injury (TBI) and to determine its effect on
functional improvement in acute inpatient rehabilitation. METHODS:: A
retrospective chart review identified male patients with a primary diagnosis of
TBI with or without a skull fracture, an onset date within 6 months prior to
admission, and were 16 years of age or older. The percentage of individuals in
this population with abnormal hormone levels was determined on the basis of the
established normal reference range for each hormone assay. The functional
independence measure, which assesses functional outcomes in acute inpatient
rehabilitation, was used to examine the relationship between hormone levels and
functional improvement. RESULTS:: Hypothalamic-pituitary dysfunction was
identified in nearly 70% of men following TBI. Hypogonadism, or low testosterone
levels, was observed in 66% of the patients, followed by low levels of free T4 in
46% and low levels of insulin growth factor-1 in 26% of patients. Hypopituitarism
associated with impaired functional recovery. Specifically, the functional
independence measure change per day was significantly lower in patients with low
levels of testosterone and insulin growth factor-1. CONCLUSIONS:: These findings
suggest the importance of testosterone and insulin growth factor-1 activity in
the early stages of physical and cognitive rehabilitation.

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