Limited adherence to growth hormone replacement in patients with traumatic brain injury

Abstract

Traumatic brain injuries can damage the pituitary gland and cause hormone deficiencies. Growth hormone deficiency is the most common hormone deficiency in patients with head injuries. These patients have adverse symptoms and poor quality of life, but it is not known whether these issues can be reversed or improved by growth hormone replacement therapy. This study investigated how many patients who started on growth hormone therapy after brain injury continued the treatment long-term. This allowed us to estimate whether the patients perceived such treatment to be beneficial. More than half (52%) of the patients with traumatic brain injury chose to continue growth hormone therapy for one year or longer. However, while some patients with brain injury may experience benefit from growth hormone replacement, it is possible that not all patients find growth hormone therapy helpful. Background: Growth hormone deficiency is a recognized consequence of traumatic brain injury. The aim of this study was to determine adherence to human growth hormone therapy among patients with traumatic brain injury compared with patients with hypothalamic or pituitary disease. Methods: A retrospective chart review of patients with traumatic brain injury referred for growth hormone stimulation testing since December 2013. Within the same electronic medical record, patients who were started on human growth hormone for aetiologies other than traumatic brain injury were reviewed. Adherence to therapy at 1-year followup was compared. Results: Of the patients with traumatic brain injury, 12/23 (52%) returned for follow-up at 1 year to continue human growth hormone treatment, whereas 11/23 (48%) did not return at 1 year. Amongst the patients with non-traumatic brain injury: 25/29 (86%) continued human growth hormone treatment, vs 4/29 (14%) who did not return. A higher proportion of patients with non-traumatic brain injury continued human growth hormone treat ment; χ 2 (1, n = 52)p = 7.238, p = 0.007. Conclusion: There may be differences in the patient-perceived benefits of human growth hormone between these patient populations. However, it is important to consider the potential influences of cognitive and psychosocial dysfunction that can occur in patients with brain injuries.

Growth hormone deficiency testing and treatment following mild traumatic brain injury

“…For patients offered rhGH who did not proceed with treatment, reasons for declining were recorded. Patients who started rhGH were dichotomized as either treatment responders or non-responders in accordance with our previously published approach whereby patients self-determine the overall value of GH replacement 39 . An individual was classified as a responder if they had self-reported symptom improvement and decided to continue therapy at their most recent clinic visit.…”