Neuropsychological recovery and quality-of-life in children and adolescents with growth hormone deficiency following TBI: A preliminary study

Abstract

Objective To compare neurocognition and quality-of-life (QoL) in a group of children and adolescents with or without growth hormone deficiency (GHD) following moderate-to-severe traumatic brain injury (TBI). Study designs Thirty-two children and adolescents were recruited from the TBI clinic at a children’s hospital. Growth hormone (GH) was measured by both spontaneous overnight testing and following arginine/glucagon stimulation administration. Twenty-nine subjects participated in extensive neuropsychological assessment. Results GHD as measured on overnight testing was significantly associated with a variety of neurocognitive and QoL measures. Specifically, subjects with GHD had significantly (p<0.05) lower scores on measures of visual memory and health-related quality-of-life. These scores were not explained by severity of injury or IQ (p>0.05). GHD noted in response to provocative testing was not associated with any neurocognitive or QoL measures. Conclusions GHD following TBI is common in children and adolescents. Deficits in neurocognition and QoL impact recovery after TBI. It is important to assess potential neurocognitive and QoL changes that may occur as a result of GHD. It is also important to consider the potential added benefit of overnight GH testing as compared to stimulation testing in predicting changes in neurocognition or QoL.

Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment?

“…In our view, there are presently limited data regarding the benefits of initiating GH therapy in asymptomatic individuals, based solely on presence of subnormal GH responses to a stimulation test. The observation that these responses are reproducible after a period of time, as it was the case in the present cohort, suggests, though, that these individuals might have an abnormal GH secretion, and some available studies in adolescents are encouraging regarding the effects of GH deficit on neurological outcome . A recent study performed in adult patients demonstrates a beneficial impact of GH treatment on neurocognitive outcome .…”

“…The observation that these responses are reproducible after a period of time, as it was the case in the present cohort, suggests, though, that these individuals might have an abnormal GH secretion, and some available studies in adolescents are encouraging regarding the effects of GH deficit on neurological outcome. 28 A recent study performed in adult patients demonstrates a beneficial impact of GH treatment on neurocognitive outcome. 29 However, prospective clinical trials are needed before recommending a systematic screening of patients after TBI and/ or GH therapy in those postpubertal or prepubertal children with normal growth.…”

Growth hormone treatment and health‐related quality of life in children and adolescents: A national, prospective, one‐year controlled study

“…GHT brought HRQOL scores up to the baseline of the controls after one year with the exception of the AGHD group who had other challenges following childhood cancer treatment similar to those reported with traumatic brain injury . This was as a result of cranial surgery, radiotherapy often combined with chemotherapy.…”

Rutin Acid Ameliorates Neural Apoptosis Induced by Traumatic Brain Injury via Mitochondrial Pathways in Mice

“…Cytochrome c release from the mitochondria leads to the sequential activation of caspases, including caspase-3, which terminates in apoptosis [34]. Here, we illustrate that the translocation of Bax to the mitochondrial membrane and cytochrome c release into the cytosol both increase after TBI, indicating that the mitochondrial apoptotic pathway is activated [35]. The described changes cause downstream activation of caspases, including the upregulation of cleaved caspase-3, which leads to neuronal apoptosis.…”