Introduction: Recent advances in medicine have allowed a considerably decrease in mortality after traumatic brain injury (TBI) with the consequent increment in the number of subjects with physical, psychological and cognitive sequelas which means an important worsening of quality of life as well as difficulties in social and labour integration. Considering that many of the symptoms classically attributed to the TBI (memory impairment, concentration impairment, fatigue, social isolation etc.) are also associated with pituitary hormones deficiency, especially growth hormone deficiency, we thought about the possibility of studying if the presence of GH deficiency could be related with psychological and neurocognitive sequelas in TBI patients, and if a hormonal replacement treatment could be an adequate complement in the rehabilitation process.
Material and methods: Eighty-three patients were studied, 65 men and 18 women, with a mean age of 43.9±1.9 years; age at TBI of 38.7±1.9 years and body mass index (BMI kg/m2) of 27.1±0.4. The severity of injury was assessed by the glasgow coma scale (GCS) score; 57 patients had suffered a mild TBI, 10 patients a moderate TBI and 14 patients a severe TBI. All patients underwent: 1) A Basal Hormonal Study: ACTH, fT3, fT4, TSH, IGF-1, FSH, LH, testosterone (male) and oestradiol (women), PRL and ADH. To assess GH secretion the GHRH+GHRP-6 test was performed. 2) Psychiatric and neurocognitive evaluation: cognitive function by using Rey-Osterrieth Complex Figure y Digit Letter Substitution Test, and presence of psycho-psychiatric symptomatology by means of Becks Depression Index and SCL-90 questionnaire
Results: In our patients neurocognitive assessment revealed a significant correlation of peak GH levels after stimulation with spatial construction, planning ability (P=0.02) and with visual short memory (P=0.003). A significant correlation of GH peak with DLST scoring, which is a measure of attention, perceptual speed, motor speed, visual scanning and memory was also observed (P<0.0001). Psycho-psychiatric evaluation revealed a significant correlation of peak GH levels with PSDI (positive symptom distress index; (P<0.0072).
Conclusion: It is important to establish the neurocognitive an psychiatric aspects potentially affected by hormonal deficiencies, especially GH deficiency, to assess the efficacy of hormone replacement therapy on neurocognitive and psychiatric alterations in TBI patients.
03 - 07 May 2008
European Society of Endocrinology