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.

Results

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.

Conclusion

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.

中文翻译：

---

生长激素缺乏症合并轻度颅脑损伤患者优化护理共识

目标/设计

美国每年约有 290 万儿童和成人遭受创伤性脑损伤 (TBI)，其中大多数为轻度损伤。TBI 可对垂体功能产生不同的后果，其中生长激素缺乏症 (GHD) 是最常见的疾病之一。由儿科和成人内分泌科医生、神经科医生、物理医学和康复专家以及神经心理学家组成的专家小组于 2020 年 2 月和 10 月召开会议，讨论持续存在的挑战，并为轻度 TBI 和 GHD 患者的检测和优化管理提供策略。

结果

困难包括人群就医率低、筛查工具欠佳、GHD 检测的成本和复杂性，以及关于何时检测或重新检测 GHD 缺乏共识。此外，从其他专家转诊至内分泌科医生的情况并不常见。治疗此类患者的专家组提出的建议包括关于 TBI 后 GHD 诊断和治疗的多学科指南，以及关于 GH 替代疗法的长期代谢和可能的认知益处的额外教育。

结论

由于所有年龄段的轻度 TBI 患者都可能出现 GHD 和/或其他垂体缺陷，因此需要采用多学科方法为内分泌科医生、神经科医生、神经外科医生、创伤科医生和其他提供者提供教育，并为早期识别和管理持续性轻度 TBI 相关的指南提供指导。迫切需要 GHD。