Hormonal and non-hormonal factors contributing to chronic fatigue in traumatic brain injury patients
Jessica Schnieders1,2,3, Ron Meijer1,2,3, Darryl Telting1,2,3 & Hans deBoer1,2,3
Introduction: Every year 30 000 patients will suffer a traumatic brain injury (TBI) in The Netherlands. About two-thirds will develop post-TBI chronic fatigue (CF). Hormone deficiencies related to pituitary damage might contribute.
Aim: To examine the clinical importance of hormonal and non-hormonal factors as issues contributing to chronic fatigue in post-TBI subjects.
Patients and methods: The checklist individual strain (CIS), a well-validated questionnaire to assess fatigue severity, was sent to 332 TBI patients, age 1865 years. The questionnaire was returned by 166 patients. A random sample of 100 fatigued and non-fatigued subjects was asked to participate: 26 females and 64 males agreed. All subjects underwent an extensive endocrine evaluation and non-hormonal causes for fatigue were studied by means of questionnaires evaluating, sleep, attention, emotional well being, quality of life, coping style, and daily activity/dependency. Physical performance was evaluated by the Æstrand bicycle test.
Results: The prevalence of severe fatigue was 51%. Fatigued subjects had more anxiety and a lower quality of life (QoL). Pituitary hormone deficiencies (PHD), defined as a subnormal serum level of one or more pituitary hormones, was present in 29% of the subjects, GH deficiency (GHD) was present in 24%, and gonadal hormone deficiencies (GnD) in 10%. PHD occurred about twice as frequently in the fatigued group (P=0.12). Vitamin D deficiency, defined as a serum 25-hydroxyvitamin D level (25-OHD) <50 nmol/l) was present in 65%. Sleep disorders and serum 25-OHD levels were related with fatigue (P<0.05), whereas PHD, gender, attention, BMI and coma duration were not.
Conclusions: Vitamin D deficiency and sleep disturbances were identified as the most important factors contributing to post-TBI fatigue. Correction of vitamin D deficiency and improvement of sleep quality might reduce fatigue in these patients.