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Hypothalamic-Pituitary Dysfunction Following Traumatic Brain Injury Affects Functional Improvement During Acute Inpatient Rehabilitation

Rosario, Emily R. PhD; Aqeel, Rubina MD; Brown, Meghan A. BA; Sanchez, Gabriel DO; Moore, Colleen BA; Patterson, David MD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: September/October 2013 - Volume 28 - Issue 5 - p 390–396
doi: 10.1097/HTR.0b013e318250eac6
Original Articles

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.

Casa Colina Hospital for Rehabilitative Medicine, Pomona, California.

Corresponding Author: Emily R. Rosario, PhD, Casa Colina Hospital for Rehabilitative Medicine, 255 E Bonita Ave, Pomona, CA 91769 (

The authors thank the Casa Colina Centers for Rehabilitation Foundation for supporting this research.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins