title: Hypothalamic-pituitary dysfunction following traumatic brain injury affects functional improvement during acute inpatient rehabilitation.
abstract: OBJECTIVE
  To evaluate the occurrence of hypothalamic-pituitary dysfunction following a traumatic brain injury (TBI) and to determine its effect on functional improvement in acute inpatient rehabilitation.
  
  
  METHODS
  A retrospective chart review identified male patients with a primary diagnosis of TBI with or without a skull fracture, an onset date within 6 months prior to admission, and were 16 years of age or older. The percentage of individuals in this population with abnormal hormone levels was determined on the basis of the established normal reference range for each hormone assay. The functional independence measure, which assesses functional outcomes in acute inpatient rehabilitation, was used to examine the relationship between hormone levels and functional improvement.
  
  
  RESULTS
  Hypothalamic-pituitary dysfunction was identified in nearly 70% of men following TBI. Hypogonadism, or low testosterone levels, was observed in 66% of the patients, followed by low levels of free T4 in 46% and low levels of insulin growth factor-1 in 26% of patients. Hypopituitarism associated with impaired functional recovery. Specifically, the functional independence measure change per day was significantly lower in patients with low levels of testosterone and insulin growth factor-1.
  
  
  CONCLUSIONS
  These findings suggest the importance of testosterone and insulin growth factor-1 activity in the early stages of physical and cognitive rehabilitation.
authors.affiliation: Casa Colina Hospital for Rehabilitative Medicine, Pomona, California.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Rosario
authors.forename: Rubina
authors.initials: R
authors.lastname: Aqeel
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Brown
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sanchez
authors.forename: Colleen
authors.initials: C
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Patterson
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation*; D015331:Cohort Studies; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D007006:Hypogonadism / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D007018:Hypopituitarism / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D007031:Hypothalamus / Q000503:physiopathology*; D007297:Inpatients; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010907:Pituitary Hormones / Q000378:metabolism; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D018570:Risk Assessment; D013739:Testosterone / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010907:Pituitary Hormones; D013739:Testosterone; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone