What are critical outcome measures for patients receiving pituitary replacement following brain injury?

Beca, Sorin; High, Walter M.; Masel, Brent E.; Mossberg, Kurt A.; Urban, Randall J.

doi:10.1007/s11102-008-0133-3

Cited by 8 publications

(9 citation statements)

References 60 publications

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“…In 1986 the genetic synthesis of rhGH, which is identical to the natural structure and function of human GH, was reported for the treatment of GHD [9] . There are also some reports of TBI patients with GH deficiency who had neurologic improvement and quality of life after being treated with rhGH [10] – [12] . The lesion sites in TBI primarily involve the frontal and temporal lobes, basal ganglia, and hippocampus, all of which can cause cognitive disorders.…”

Section: Introductionmentioning

confidence: 99%

The Effect and Mechanism of Growth Hormone Replacement on Cognitive Function in Rats with Traumatic Brain Injury

et al. 2014

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ObjectiveThe effects of growth hormone on cognitive dysfunction were observed in a controlled cortical impact (CCI) rat model and the underlying mechanism was explored.MethodThree-month-old male SD rats were randomly divided into sham (n = 10), control (n = 10), and CCI groups (n = 40) The parameters were set as follows: striking speed, 3.5 m/s; impact depth, 1.5 mm; and dwell time, 400 msec. Eight and ten weeks post-injury, the GH levels were measured the water maze test and novel object recognition test were performed. CCI rats were divided into normal and decreased GH groups, and further randomly divided into two sub-groups (rhGH treatment and saline vehicle groups). All rats were tested for SYN, BDNF, and TrkB mRNA in the prefrontal cortex and hippocampus by RT-PCR.ResultsCCI rats 8 weeks post-injury had cognitive dysfunction regardless of the GH level (P<0.05). rhGH treatment improved cognitive function in CCI rats. There was a positive correlation between the expression of prefrontal BDNF and SYN mRNA in CCI rats after rhGH therapy and the water maze test score (r = 0.773 and 0.534, respectively; P<0.05). Furthermore, the expression of BDNF, TrkB, and SYN mRNA in the hippocampus was negatively correlated with the water maze test score (r = 0.602, 0.773, 0.672, and 0.783, respectively; P<0.05). There was a difference in the expression of hippocampal and prefrontal BDNF, TrkB, and SYN mRNA (P<0.05)ConclusionrhGH treatment had a positive effect on cognitive function, which was more evident in GH-deficient rats. The increased expression of hippocampal and prefrontal BDNF and TrkB mRNA is implicated in rhGH therapy to improve cognitive function. Changes in the expression of hippocampal SYN mRNA following rhGH therapy may also play a role in improving cognitive function.

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Section: Introductionmentioning

confidence: 99%

The Effect and Mechanism of Growth Hormone Replacement on Cognitive Function in Rats with Traumatic Brain Injury

et al. 2014

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“…Despite the clear evidence that large numbers of persons with TBI have GHD, very few are actually screened for pituitary dysfunction, possibly because the establishment of a linkage between GHD and cognitive impairment after TBI has not been definitively made (Beca et al, 2008). Moreover, the literature on GH replacement after TBI is scant.…”

Section: Introductionmentioning

confidence: 99%

Effect of Growth Hormone Replacement Therapy on Cognition after Traumatic Brain Injury

High

Briones-Galang

Clark

et al. 2010

Journal of Neurotrauma

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144

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Traumatic brain injury (TBI) is a major public health issue, and yet medical science has little to offer for the persistent symptoms that prevent many of these individuals from fully re-entering society. Post-traumatic hypopituitarism, and specifically growth hormone deficiency (GHD), has been found in a large percentage of individuals with chronic moderate to severe TBI. Presently, there are no published treatment studies of hormone replacement in this population. In this study, 83 subjects with chronic TBI were screened for hypopituitarism. Forty-two subjects were found to have either GHD or GH insufficiency (GHI), of which 23 agreed to be randomized to either a year of GH replacement or placebo. All subjects completed the study with no untoward side effects from treatment. A battery of neuropsychological tests and functional measures were administered before and after treatment. Improvement was seen on the following tests: Dominant Hand Finger Tapping Test, Wechsler Adult Intelligence Scale III-Information Processing Speed Index, California Verbal Learning Test II, and the Wisconsin Card Sorting Test (executive functioning). The findings of this pilot study provide preliminary evidence suggesting that some of the cognitive impairments observed in persons who are GHD/GHI after TBI may be partially reversible with appropriate GH replacement therapy.

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“…Studies addressing prolactin secretion dysfunction following traumatic brain injury are variable in their results [ 12 , 16 , 18 , 24 , 25 , 26 , 29 , 32 , 36 ]. This paucity of quality data may be the result of a perceived lack of clinical significance relative to other hormones such as cortisol, thyroid stimulating hormone and growth hormone [ 73 ].…”

Section: Tbi Related Anterior Pituitary Dysfunctionmentioning

confidence: 99%

Impaired Pituitary Axes Following Traumatic Brain Injury

Scranton

Baskin

2015

JCM

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Pituitary dysfunction following traumatic brain injury (TBI) is significant and rarely considered by clinicians. This topic has received much more attention in the last decade. The incidence of post TBI anterior pituitary dysfunction is around 30% acutely, and declines to around 20% by one year. Growth hormone and gonadotrophic hormones are the most common deficiencies seen after traumatic brain injury, but also the most likely to spontaneously recover. The majority of deficiencies present within the first year, but extreme delayed presentation has been reported. Information on posterior pituitary dysfunction is less reliable ranging from 3%–40% incidence but prospective data suggests a rate around 5%. The mechanism, risk factors, natural history, and long-term effect of treatment are poorly defined in the literature and limited by a lack of standardization. Post TBI pituitary dysfunction is an entity to recognize with significant clinical relevance. Secondary hypoadrenalism, hypothyroidism and central diabetes insipidus should be treated acutely while deficiencies in growth and gonadotrophic hormones should be initially observed.

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What are critical outcome measures for patients receiving pituitary replacement following brain injury?

Cited by 8 publications

References 60 publications

The Effect and Mechanism of Growth Hormone Replacement on Cognitive Function in Rats with Traumatic Brain Injury

The Effect and Mechanism of Growth Hormone Replacement on Cognitive Function in Rats with Traumatic Brain Injury

Effect of Growth Hormone Replacement Therapy on Cognition after Traumatic Brain Injury

Impaired Pituitary Axes Following Traumatic Brain Injury

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