Growth hormone deficient patients after traumatic brain injury – Baseline characteristics and benefits after growth hormone replacement – An analysis of the German KIMS database

Kreitschmann-Andermahr, Ilonka; Poll, E; Reineke, A; Gilsbach, Joachim M.; Brabant, Georg; Buchfelder, Michael; Faßbender, Walter Josef; Faust, Michael; Kann, Peter Herbert; Wallaschofski, Henri

doi:10.1016/j.ghir.2008.08.007

Cited by 64 publications

(42 citation statements)

References 27 publications

(29 reference statements)

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“…The only marker of adverse body composition in the TBI group is the finding of lower lean muscle mass, which may represent disuse atrophy. We have shown that similar to previous KIMS data (24,25), patients post TBI were shorter than counterparts with NFPA. Subgroup analysis has shown that this difference can be accounted for by patients whose injury date was before 19 years of age (data not shown).…”

Section: Discussionsupporting

confidence: 90%

“…We demonstrated once again a significant lag time between injury date and diagnosis of GHD, with patients with TBI diagnosed over 2 years later than NFPA patients. This lag was observed in the two previous KIMS studies (24,25). It may be that a reduction in the lag time is observed in future studies.…”

Section: Discussionsupporting

confidence: 55%

“…Subsequent to this, a further interrogation of the German KIMS database in October 2006 found 69 cases of GHR for this indication (25). These data may suggest deficiencies in the neuroendocrine evaluation of patients after TBI and potentially a very high prevalence of undiagnosed and symptomatic TBI-related GHD and hypopituitarism.…”

Section: Introductionmentioning

confidence: 95%

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GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

Gardner

Mattsson

Daousi

et al. 2015

European Journal of Endocrinology

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Objective: Prevalence of 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. The aim of this study was to analyse the clinical characteristics of post-traumatic hypopituitarism and the QoL effects of long-term GHR. Design/methods: 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 relationship with country-specific norms. Results: TBI patients compared with 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; PZ0.004) and received higher GH dose (mean difference: 0.04 mg/day PZ0.006). In TBI patients, 1-year improvement in QoL was greater than in NFPA (change in QoL-AGHDA score 5.0 vs 3.5, respectively, PZ0.04) 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 with 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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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 55%

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GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

Gardner

Mattsson

Daousi

et al. 2015

European Journal of Endocrinology

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“…There are limited data on treatment effect in this specific subpopulation of patients with anterior pituitary hormone deficiency. Two studies have compared clinical and other outcome variables measured at baseline and after one year of hGH replacement in TBI patients and in patients with non-functioning pituitary adenoma (NFPA) from Pfizer International Metabolic (KIMS) database Kreitschmann-Andermahr et al, 2008). At one-year follow-up, IGF-I SDS levels had increased to the normal range, and improved QoL was observed, in TBI as in NFPA patients, suggesting that TBI patients with GH deficiency benefit from hGH replacement in terms of improved QoL in a similar fashion as do NFPA patients.…”

Section: Chronic Phasementioning

confidence: 99%

The Case of Hypopituitarism in Traumatic Brain Injury

Marianne¹,

Ulla²

2012

Brain Injury - Functional Aspects, Rehabilitation and Prevention

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“…2,25,42 Late diagnosis and late initiation of treatment lead to shorter adult height related to less remaining time to continue growing taller. 42 Early intervention with GH (at a young age and before height SD drifts to -3 SD) can lead to not only better height outcome, but also better long-term psychosocial adjustment. 26,36 Delay of initiation of GH therapy often occurs in cancer survivors.…”

Section: Accurate and Early Identification Of Growth Hormone Deficiencymentioning

confidence: 99%

Optimal Therapy of Growth Hormone Deficiency in the Child and Adolescent

Rose¹

2010

European Endocrinology

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Paediatric endocrinologists aspire to provide the best care for children, including improving outcomes in growth hormone deficiency (GHD).The challenging issues are sometimes simple ones, such as which children should be seen in the endocrine clinic for evaluation of their growth, or standards for diagnosis of GHD, or methods of delivering standard therapy for GHD.1 Historically accepted solutions require review as knowledge and technology advance. 2-4This article addresses ways to optimise treatment strategy for children diagnosed with GHD. Optimal therapy of growth disorders depends on accurate diagnosis of the aetiology and identification of the goals of therapy. It is important to understand normal patterns of growth hormone (GH) and insulin-like growth factor (IGF) secretion in order to appreciate differences between normal physiology and hormone patterns induced by therapy. Finally, monitoring for efficacy and safety, identification of interfering factors and making appropriate dose adjustment are all part of optimising GH therapy in childhood GHD. Accurate DiagnosisMany factors besides GH participate in the regulation of normal growth (nutrition, thyroid hormone, genetics, prenatal health, family growth patterns and psychosocial adjustment [see Figure 1]). GH has been administered to children with severe GHD since 1958. Of course, there is no difficulty in making the diagnosis of GHD when the condition is severe. However, with the increasing availability of synthetic recombinant GH, GH therapy has been used in more conditions (see Figure 2). 5 There continues to be controversy about methods for accurate diagnosis of milder degrees of GHD, as well as controversy about which children should be treated with GH.Standardisation of GH assays and cutoff values for normal GH secretion may permit more uniform diagnosis, enabling therapy decisions to be based on reliable data from assays. Goals of TherapyThe purpose of GH treatment must be considered. GH therapy clearly speeds up linear growth in the GHD child and adolescent. However, GHD leads to metabolic effects in addition to slowed linear growth. In untreated GHD, body composition is altered with increased fat mass, decreased lean body mass and decreased accrual of bone mineral. 8-10In addition, individuals with GHD may have decreased exercise tolerance and a sense of fatigue, along with a raised risk for AbstractOptimal therapy of growth disorders depends on accurate diagnosis and clear goals for therapy. Understanding normal patterns of growth hormone (GH) and insulin-like growth factor (IGF) secretion are necessary to appreciate the different hormone pattern induced by therapy.Finally, monitoring efficacy and safety, identifying interfering factors and adjusting doses are all part of optimising GH therapy in childhood GH deficiency (GHD). Prevention of development of GHD would avoid the need for therapy. Options for optimising GH therapy in childhood GHD include initiating treatment as young as possible, facilitating adherence to a therapy plan and adjusti...

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Growth hormone deficient patients after traumatic brain injury – Baseline characteristics and benefits after growth hormone replacement – An analysis of the German KIMS database

Cited by 64 publications

References 27 publications

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

GH deficiency after traumatic brain injury: improvement in quality of life with GH therapy: analysis of the KIMS database

The Case of Hypopituitarism in Traumatic Brain Injury

Optimal Therapy of Growth Hormone Deficiency in the Child and Adolescent

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