Bushnik Tamara, Englander Jeffrey, Katznelson Laurence
Rehabilitation Research Center, San Jose, CA 95128, USA.
Brain Inj. 2007 Jun;21(6):559-66. doi: 10.1080/02699050701426915.
Evaluate the association between neuroendocrine findings and fatigue after traumatic brain injury (TBI) Research design: Prospective, observational.
Sixty-four individuals at least 1 year post-TBI underwent neuroendocrine testing including thyroid, adrenal, gonadal axes and growth hormone (GH) after glucagon stimulation with assessment of fatigue using the Global Fatigue Index (GFI) and the Fatigue Severity Scale (FSS).
GFI and FSS scores were significantly higher within this sample compared to published control data. At least one pituitary axis was abnormal in 90% of participants. Higher GH levels were significantly associated with higher FSS scores. There was a noted trend between lower basal cortisol and higher scores on both the FSS and GFI.
The association between higher GH levels and greater fatigue contradicted the prevailing hypothesis that post-acute TBI fatigue is associated with GH deficiency. The association between lower basal cortisol and greater fatigue was in the expected direction. While no other trends were noted, the fatigue derived from neuroendocrine abnormalities alone may be masked by fatigue induced by other factors commonly experienced following TBI. Given the high prevalence of pituitary abnormalities, screening for hypopituitarism after TBI is a reasonable recommendation. The contribution of GH deficiency to diminished quality of life post-TBI remains unclear.
评估创伤性脑损伤（TBI）后神经内分泌检查结果与疲劳之间的关联。研究设计：前瞻性观察研究。
64名TBI后至少1年的个体接受了神经内分泌检查，包括甲状腺、肾上腺、性腺轴以及胰高血糖素刺激后的生长激素（GH），并使用全球疲劳指数（GFI）和疲劳严重程度量表（FSS）评估疲劳情况。
与已发表的对照数据相比，该样本中的GFI和FSS评分显著更高。90%的参与者至少有一个垂体轴异常。较高的GH水平与较高的FSS评分显著相关。基础皮质醇水平较低与FSS和GFI评分较高之间存在明显趋势。
较高的GH水平与更严重的疲劳之间的关联与急性TBI后疲劳与GH缺乏相关的普遍假设相矛盾。基础皮质醇水平较低与更严重的疲劳之间的关联符合预期方向。虽然未观察到其他趋势，但仅由神经内分泌异常引起的疲劳可能会被TBI后常见的其他因素引起的疲劳所掩盖。鉴于垂体异常的高发生率，TBI后筛查垂体功能减退是一项合理的建议。GH缺乏对TBI后生活质量下降的影响仍不清楚。
