Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Brain Inj. 2022 Apr 16;36(5):607-619. doi: 10.1080/02699052.2022.2068185. Epub 2022 May 4.
Determine if an abnormal preliminary neuroendocrine disorder (NED) blood test screen is associated with mild TBI (mTBI) history or post-concussiveclinical features.
Observational.
Among 1,520 participants with military combatexposure, we measured randomly timed serum levels of insulin-likegrowth factor-1, thyroid stimulating hormone (TSH), and total testosterone as a preliminary NED screen. Using multivariable models, we analyzed relation of screen results in mTBI group membership and post-concussiveclinical features (fatigue, depression, cognitive symptoms, executive function, processing speed).
None of the mTBI positive groups, including repetitive (≥3 mTBI) and blast-related,differed from the non-TBIcontrols on rates of abnormal lab screen or rates of growth hormone deficiency (GHD), hypothyroidism or male hypogonadism in treatment records. Lab screen findings were also not associated with any clinical feature.
This study shows no evidence that remote mTBI(s) or implicated post-concussiveclinical features are linked to GHD, hypothyroidism or male hypogonadism. Large case-controlstudies incorporating more definitive neuroendocrine disorder NED testing (TSH plus thyroxine, early morning testosterone, LH, FSH, prolactin and GH provocative testing) are needed to determine whether mTBI(s) alone elevate one's risk for chronic NED and how best to select patients for comprehensive testing.
确定异常初步神经内分泌紊乱 (NED) 血液检测结果是否与轻度创伤性脑损伤 (mTBI) 病史或脑震荡后临床特征相关。
观察性研究。
在 1520 名具有军事战斗暴露的参与者中，我们随机测量了血清胰岛素样生长因子-1、促甲状腺激素 (TSH) 和总睾酮水平作为初步的 NED 筛查。我们使用多变量模型分析了筛查结果与 mTBI 组和脑震荡后临床特征（疲劳、抑郁、认知症状、执行功能、加工速度）之间的关系。
没有一个 mTBI 阳性组，包括重复性（≥3 次 mTBI）和与爆炸相关的 mTBI，在异常实验室筛查率或生长激素缺乏症（GHD）、甲状腺功能减退症或男性性腺功能减退症的治疗记录率方面与非 TBI 对照组不同。实验室筛查结果也与任何临床特征无关。
本研究没有证据表明远程 mTBI 或相关的脑震荡后临床特征与 GHD、甲状腺功能减退症或男性性腺功能减退症有关。需要进行更大规模的病例对照研究，纳入更明确的神经内分泌紊乱 NED 检测（TSH 加甲状腺素、清晨睾酮、LH、FSH、催乳素和 GH 激发试验），以确定 mTBI 是否会单独增加慢性 NED 的风险，以及如何最好地选择患者进行全面检测。
