The following article is a part of conference coverage from the American Association of Clinical Endocrinology Annual Meeting 2021: ENVISION, being held virtually from May 26 to May 29, 2021. The team at Endocrinology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the AACE Annual Meeting 2021: ENVISION.

 

Both pediatric and adult patients who sustain mild traumatic brain injury (TBI) may experience pituitary deficiencies and/or growth hormone deficiencies resulting from their injuries, according to research presented at the 30th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists (ENVISION 2021).


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Approximately 2.5 million US children and adults experience TBI each year. These injuries can have a long-term impact on pituitary function, including growth hormone deficiency. Symptoms of growth hormone deficiency are typically nonspecific and can include decreased quality of life, muscle mass, and physical capacity as well as increased visceral fat, poor growth, fatigue, and impaired cognitive function.

Researchers sought to both identify and discuss ongoing challenges and preventive strategies for clinicians to detect and manage patients with mild TBI-induced growth hormone deficiency.

The investigators convened a panel of pediatric and adult endocrinologists, neurologists, physical medicine and rehabilitation specialists, neuropsychologists, and brain injury medicine specialists as members of advisory boards. The panel identified numerous challenges associated with the diagnosis and treatment of growth hormone deficiency in patients with mild TBI. These include the availability of only suboptimal screening tools; the cost and complexity of growth hormone deficiency testing, as well as barriers to access; issues with insurance reimbursement; and a lack of consensus on whether growth hormone deficiency should be tested in these patients.

The panel also found an absence of referrals of patients to endocrinologists from physicians in other specialties who treat patients with TBIs and reported that many of these specialists are not aware of the need to assess these patients for growth hormone deficiency.

There is also a “large community” of clinicians who believe that concussions or mild TBIs are benign. However, the researchers indicated that between 15% and 50% of patients who have concussions can experience residual symptoms at 1 year. The researchers noted that this belief likely contributes to the lack of referrals for growth hormone deficiency diagnostic testing.

There is also a broad variation in how advisory panels identify patients with mild TBI who require screening for potential growth hormone deficiencies. This result indicates that abnormalities in pituitary hormones can be difficult to confirm.

To address these challenges, the panel developed brief recommendations for managing growth hormone deficiency in patients with mild TBI. These recommendations include the creation of multidisciplinary, evidence-based guidelines on the diagnosis and management of post-mild TBI-induced growth hormone deficiency; these guidelines should include both indications and methods for screening and testing.

The second recommendation is for additional research and physician education on the long-term metabolic and cognitive benefits of growth hormone replacement therapy in pediatric and adult patients.

“Patients of all ages with mild TBI may also have [growth hormone deficiency] and/or other pituitary deficiencies,” the researchers concluded. “An evidence-based multidisciplinary approach to provide education to endocrinologists and other providers who may manage mild TBI, focusing on guidelines for the early identification and management of [growth hormone deficiency] related to mild TBI, is urgently needed.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Yuen KCJ, Masel B, Jaffee MS, et al. Growth hormone deficiency in patients with mild traumatic brain injury: insights from a US advisory board. Presented at: 2021 AACE Virtual Annual Meeting, May 26-29, 2021.