Category: Pituitary Disorders/Neuroendocrinology

Monitor: 33

33 - EFFECTS OF GROWTH HORMONE REPLACEMENT THERAPY IN PATIENTS SUFFERING TRAUMATIC BRAIN INJURIES WITH GROWTH HORMONE DEFICIENCY

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective : Many patients with traumatic brain injury (TBI) suffer an injury to the hypothalamic-pituitary axis, with the majority having growth hormone deficiency (GHD). These patients suffer from various symptoms, including cognitive, emotional, and physical disabilities. However, it may not be clear which symptoms are related to dysfunction of the pituitary gland/GHD, and are treatable or caused by injury to the brain itself and likely permanent.The objective of this study was to determine which symptoms and health-related issues may be ameliorated by growth hormone replacement therapy (GHRT).


Methods : We studied 67 largely mild TBI patients that were found to have GHD using the insulin-tolerance test (ITT). Patients were defined as growth hormone deficient if their peak growth hormone level was < 5.0 ng/mL. The standardized AGHDA- Quality of Life Questionnaire and a self report was used at baseline and at one-year post GH treatment, with patients on their optimal dosage of growth hormone. 


Results : Prior to treatment, patients complained of physical symptoms, followed by emotional, and then cognitive symptoms. Post treatment 85% of patients reported improvement in physical symptoms, 63% of patients reported improvement in emotional symptoms, and 45% of patients reported improvement in cognitive function. Also, 97% of the patients indicated that their quality of life indeed had improved. Patients reported medication use before and at one-year follow-up. 31 of 67 patients (46%) were on psychotropic or sleep medications at baseline, and 14 (45%) were able to discontinue these medications after reporting improvement after taking GH injections. Of 62 subjects, 15 (21%) were on prescription pain medication at baseline, with 3 (20%) discontinuing these medications altogether, and the majority being able to reduce the dosage and/or strength. Serum lipid levels improved with GH: Total cholesterol levels dropped by 10 mg/dL (5%) without other lipid reducing intervention, with a baseline mean of 206 mg/dL and mean level at one-year of 196 mg/dL. Low density lipoprotein (LDL) level also dropped, with a pre-treatment mean of 125 mg/dL, and 108 mg/dL at one year (decreased 13.6%).


Discussion : Our study suggests that treatment with growth hormone for TBI patients with GH deficiency greatly improves a number of indices relating to quality of life and overall health. This is a significant finding in a subset of TBI patients who may not follow the typical recovery trajectory of TBI.


Conclusion :

This retrospective study is limited, as it is not placebo controlled; however, the range of symptoms and health-related indices that responded to GH replacement suggests the need for clinical trials using GHRT in TBI patients.

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Ali M. Dakka

Medical student
Metro Detroit Endocrinology Center
Dearborn Heights, Michigan

Currently, I am a second-year medical student at the Wayne State University School of Medicine. I have been working on our growth hormone replacement study since last year. What drove me to participate in this project was my love for sports; I have seen several athletes from different sports suffer traumatic brain injuries and desired to explore how such injuries can be managed. Recently, the members of my student organization (Auntie Na’s Student Organization) and I presented two posters at the Sujal Parikh Memorial Symposium for Health and Social Justice at the University of Michigan-Ann Arbor, where we showcased the efforts that we have made to reach out to and support a local Detroit community, such as through a free health clinic, literacy promotion, and health education.

I graduated from the University of Michigan-Ann Arbor in April of 2017 with a B.S. in Cellular and Molecular Biology and had two research experiences. One was from 2015 to 2016, when I investigated how SIRT6 affects glycolytic enzymes and also explored the mechanisms by which
melanoma cells die in response to deletion of the Sirt5 gene. The other was in the summer of 2014, when I participated in the University of California, San Diego (UCSD) MSTP Summer Undergraduate Research Fellowship. I led a project focusing on the effects of the deletion
of PHLPP2, a tumor suppressor, on the signaling pathways in the heart and the brain and presented my work at the UCSD Summer Research Conference at the end of the program.

My background shows that I have a strong interest in experiencing the clinical and research aspects of the medical field along with making an impact on the local community. I look forward to continuing my efforts during my medical career.

Farah Ahmed

Clinical Research Coordinator
Metro Detroit Endocrinology Center

Farah is the Clinical Research Coordinator at the Metro Detroit Endocrinology Center located in Dearborn, Michigan, USA. She completed her Bachelors of Science Degree with Honors in 2014 and went on to pursue a Masters of Science degree at Illinois Institute of Technology in 2016. Her research experience includes Neuroendocrinology, Type 1 Diabetes, Type 2 Diabetes, Prediabetes, Growth Hormone Deficiency and Adrenal Insufficiency, as well as Genetics, Bioinformatics and Cognitive Neuroscience.

Vijay Baragi

Chief Scientific Officer
Center for Neurological Studies
Novi, Michigan

Dr. Vijay Baragi has more than 25 years of experience in drug discovery and development. He has a proven track record in advancing a comprehensive portfolio in multiple therapeutic areas. He managed a portfolio of 13 small molecule and monoclonal antibody programs in neuropathic/inflammatory pain, cancer, multiple sclerosis, inflammatory bowel disease, and cardiovascular disease therapeutic areas spanning from target validation to Phase III clinical development. He has championed the advancement of three molecules to Investigational New Drug (IND) and one to Phase III completion (contributed to development and filing of a New Drug Application (NDA) as a mid-level manager). In addition, he has extensive experience interacting with potential collaborators/partners, investors, and financial professional and academic collaborators

Randall Benson

Physician -Co-Investigator
Center for Neurological Studies

Dr. Benson is a board certified physician obtaining his MD at Washington University. He completed his residency and fellowship training in Neurology and Behavioral Neurology and Functional Neuroimaging. He was an Assistant Professor in Neurology with the Wayne State School of Medicine. His areas of interest include but are not limited to, TBI in former NFL Players, Pituitary Hormonal Effects in TBI, Neurovascular Effects in MS and Neuromodulation of the Brain using Electrical and Magnetic Stimulation. Dr. Benson has been invited to lecture at various conferences across the United States. He continues to divide his time between treating patients, research activities and teaching opportunities.

Opada Alzohaili

Physician- Principle Investigator
Metro Detroit Endocrinology Center

Dr. Alzohaili is a board certified endocrinologist with over 20 years experience. He specializes in Traumatic Brain Injuries, Pituitary Deficiencies, Growth Hormone Deficiency, Adrenal Insufficiency, Diabetes, Thyroid Disorders, hormone Imbalances, and Osteoporosis.
He is the Clinical Assistant Professor at Wayne State University, Chief of Endocrinology, active teaching staff in endocrine and medicine programs at several local hospitals.
He is a frequent national and international speaker in various countries. He has also written several publications and received numerous awards for teaching.
He is the founder of Metro Detroit Endocrinology Center; one of the busiest endocrinology centers with emphasis on Traumatic Brain Injury and Pituitary Gland Disease.