Research Reports - Growth Hormone Deficiency after Traumatic Brain Injury: improvement in quality of life with GH therapy

Eur J Endocrinol. 2015 Jan 12

Gardner CJ(1), Mattsson AF(2), Daousi C(3), Korbonits M(4), Koltowska-Haggstrom
M(5), Cuthbertson DJ(6)

Objective: Prevalence of growth hormone (GH) deficiency (GHD) caused by traumatic
brain injury (TBI) is highly variable. Short-term studies show improvement in
quality of life (QoL) during GH replacement (GHR), but long-term data are
lacking. This study aimed to analyse the clinical characteristics of post
traumatic hypopituitarism and the QoL effects of long-term GHR. Design/Methods:
KIMS (Pfizer International Metabolic Database) patients with GHD caused by TBI
and by non-functioning pituitary adenoma (NFPA) were compared regarding: clinical
characteristics at baseline and 1-year of GHR, and QoL response up to 8-years of
GHR (QoL-AGHDA total scores and dimensions) in relation to country-specific
norms. Results: TBI patients compared to NFPA patients: were younger, diagnosed
with GHD 2.4 years later after primary disease onset (p<0.0001), had a higher
incidence of isolated GHD, higher GH peak, a more favourable metabolic profile
and worse QoL, were shorter by 0.9 cm (1.8 cm when corrected for age and gender;
p=0.004) and received higher GH dose (mean difference: 0.04 mg/day p=0.006). In
TBI patients, 1-year improvement in QoL, was greater than in NFPA (change in
QoL-AGHDA score 5.0 vs. 3.5, respectively, p=0.04) and was sustained over
8-years. In TBI patients, socialisation normalised after 1 year of GHR,
self-confidence and tenseness after 6 years and no normalisation of tiredness and
memory was observed. Conclusion: Compared to NFPA, TBI patients presented
biochemically with less severe hypopituitarism and worse QoL scores. GHR achieved
clinically relevant, long-term benefit in QoL.

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