Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA.
Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA.
Growth Horm IGF Res. 2022 Oct;66:101495. doi: 10.1016/j.ghir.2022.101495. Epub 2022 Jul 25.
OBJECTIVE/DESIGN: Approximately 2.9 million children and adults in the US experience traumatic brain injuries (TBIs) annually, most of which are considered mild. TBI can induce varying consequences on pituitary function, with growth hormone deficiency (GHD) among the more commonly reported conditions. Panels of pediatric and adult endocrinologists, neurologists, physical medicine and rehabilitation specialists, and neuropsychologists convened in February and October 2020 to discuss ongoing challenges and provide strategies for detection and optimal management of patients with mild TBI and GHD.
Difficulties include a low rate of seeking medical attention in the population, suboptimal screening tools, cost and complexity of GHD testing, and a lack of consensus regarding when to test or retest for GHD. Additionally, referrals to endocrinologists from other specialists are uncommon. Recommendations from the panels for managing such patients included multidisciplinary guidelines on the diagnosis and management of post-TBI GHD and additional education on long-term metabolic and probable cognitive benefits of GH replacement therapy.
As patients of all ages with mild TBI may develop GHD and/or other pituitary deficiencies, a multidisciplinary approach to provide education to endocrinologists, neurologists, neurosurgeons, traumatologists, and other providers and guidelines for the early identification and management of persistent mild TBI-related GHD are urgently needed.
目的/设计： 美国每年约有 290 万儿童和成人经历创伤性脑损伤（TBI），其中大多数被认为是轻度的。TBI 可能对垂体功能产生不同的影响，其中生长激素缺乏症（GHD）是更常见的病症之一。儿科和成人内分泌学家、神经科医生、物理医学和康复专家以及神经心理学家于 2020 年 2 月和 10 月召开会议，讨论持续存在的挑战，并提供了检测和优化轻度 TBI 和 GHD 患者管理的策略。
存在的困难包括该人群中寻求医疗关注的比率较低、筛选工具不理想、GHD 检测的成本和复杂性，以及关于何时进行 GHD 检测或重新检测的共识缺乏。此外，其他专家向内分泌科医生的转介也不常见。专家组提出的此类患者管理建议包括关于创伤后 GHD 的诊断和管理的多学科指南，以及关于 GH 替代疗法的长期代谢和可能认知益处的额外教育。
由于所有年龄段的轻度 TBI 患者都可能发生 GHD 和/或其他垂体功能减退症，因此迫切需要多学科方法来为内分泌学家、神经科医生、神经外科医生、创伤学家和其他提供者提供教育，并制定早期识别和管理持续性轻度 TBI 相关 GHD 的指南。
