CONSEQUENCES OF HYPOPITUITARISM FOLLOWING TRAUMATIC BRAIN INJURY (TBI)

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 假设： 该方案将调查创伤性脑损伤(TBI)相关的垂体功能减退对身体成分、生活质量(QOL)和日常生活能力(ADL)的影响。我们假设： 1.颅脑损伤与高度垂体功能低下有关，包括生长激素缺乏。 2.与垂体功能正常的患者相比，脑外伤患者的垂体功能低下与骨骼肌重减少、体脂增加、生活质量下降和日常生活活动能力下降有关。 3.在有颅脑损伤病史的患者中，垂体功能低下的程度与骨骼肌质量、体脂、生活质量和日常生活活动能力的恶化程度相关。 目标： 脑损伤具有深远的临床和经济后果。常见的损伤后遗症包括神经或神经肌肉损伤、认知功能障碍、身体条件解除、体重增加或脂肪重新分配，以及生活质量和整体表现下降。这些后遗症已被确定为成功康复的主要障碍。许多颅脑损伤患者未能完全康复，进入慢性残疾和失业阶段。 甲状旁腺功能减退症被广泛认识，替代疗法的重要性也得到了很好的理解。脑下垂体前叶功能障碍可能导致生长激素(GH)、甲状腺、糖皮质激素、性激素(男性的睾酮/女性的雌激素)和催乳素的产生。一般来说，垂体功能减退的患者会出现疲劳和体重增加或减少，并可能有一个或多个荷尔蒙轴受损。中枢性甲状腺功能减退症广泛影响呼吸、心血管、神经和肌肉骨骼系统，因此与疲劳、运动耐力差、记忆力受损有关，并导致虚弱和肌病。男性性腺机能减退(睾丸激素缺乏)会对身体成分、骨密度和神经心理社会功能产生不利影响。男性缺乏睾丸素可能会导致行为和认知方面的后果，包括情绪紊乱、语言流畅性降低、记忆力受损和生活质量低下。越来越多的文献表明中枢性性腺功能低下的女性患者存在相对的雄激素缺乏，这可能会对瘦体重和功能产生不利影响。慢性肾上腺功能不全的症状和体征包括身体不适、乏力、乏力、食欲不振和体重减轻。在严重和慢性病例中，患者可能有神经精神症状，如记忆力丧失、器质性脑综合征、抑郁和明显的精神病。 这项初步研究将包括一项横断面设计，年龄在18-55岁之间的男性和女性在颅脑损伤后6个月。对照受试者将在治疗后通过正常的垂体功能来确定。我们将测试每个受试者的身体成分、生活质量和日常生活能力，以比较甲状腺功能减退与正常受试者的差异，并将垂体腺功能减退的程度与结果的不同程度相关联。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypotheses: This protocol will investigate the effect of traumatic brain injury (TBI)-associated hypopituitarism on body composition, quality of life (QOL), and activities of daily living (ADL). We hypothesize that: 1. TBI is associated with a high degree of hypopituitarism, including growth hormone deficiency. 2. Hypopituitarism in patients with TBI is associated with diminished skeletal muscle mass and increased body fat, decreased QOL, and decreased ability to perform ADL compared to patients with normal pituitary function. 3. In patients with history of TBI, the degree of hypopituitarism correlates with the degree of deterioration in skeletal muscle mass, body fat, QOL, and ADL. Goals: TBI has profound clinical and economic consequences. Common sequelae of injury include neurologic or neuromuscular damage, cognitive dysfunction, physical deconditioning, weight gain, or fat redistribution, as well as diminished quality of life and overall performance. These sequelae have been identified as major obstacles to successful rehabilitation. Many TBI patients fall short of complete recovery altogether and enter into a phase of chronic disability and unemployment. The syndrome of hypopituitarism is widely recognized, and the importance of replacement therapy well understood. Dysfunction of the anterior pituitary gland may lead to a compromise in growth hormone (GH), thyroid, glucocorticoid, sex hormone (testosterone in men/estrogen in women), and prolactin production. In general, patients with hypopituitarism present with fatigue and either weight gain or loss, and may have one or more hormone axes compromised. Central hypothyroidism widely impacts the respiratory, cardiovascular, neurologic, and musculoskeletal systems and therefore is associated with fatigue, poor exercise tolerance, impaired memory, and cause weakness and myopathy. Hypogonadism (testosterone deficiency) in men can lead to adverse affects on body composition, bone density, and neuropsychosocial function. Testosterone deficiency in men can have behavioral and cognitive consequences including mood disturbances, decreased verbal fluency, impaired memory, and poor QOL. There is a growing literature on the relative androgen deficiency in female patients with central hypogonadism, which may have adverse consequences on lean mass and function. Signs and symptoms of chronic adrenal insufficiency include malaise, lassitude, weakness, anorexia, and weight loss. In severe and chronic cases, patients may have neuropsychiatric manifestations such as memory loss, organic brain syndrome, depression, and overt psychosis. This pilot study will consist of a cross-sectional design with men and women between 18-55 years old 6 months following TBI. Control subjects will be identified posthoc by normal pituitary function. We will test body composition, QOL, and ADL in each subject to compare differences in hypopituitary vs. normal subjects and also correlate degree of hypopituitarism to degree of differences in outcomes.