Alterations of the GH/IGF-I Axis and Gut Microbiome after Traumatic Brain Injury: A New Clinical Syndrome?
Open accessAbstract
Context: Pituitary dysfunction with abnormal growth hormone (GH) secretion and neurocognitive deficits are common consequences of traumatic brain injury (TBI). Recognizing the comorbidity of these symptoms is of clinical importance; however, efficacious treatment is currently lacking. Evidence Acquisition: A review of studies in PubMed published between January 1980 to March 2020 and ongoing clinical trials was conducted using the search terms “growth hormone,” “traumatic brain injury,” and “gut microbiome.” Evidence Synthesis: Increasing evidence has implicated the effects of TBI in promoting an interplay of ischemia, cytotoxicity, and inflammation that renders a subset of patients to develop postinjury hypopituitarism, severe fatigue, and impaired cognition and behavioral processes. Recent data have suggested an association between abnormal GH secretion and altered gut microbiome in TBI patients, thus prompting the description of a hypothesized new clinical syndrome called “brain injury associated fatigue and altered cognition.” Notably, these patients demonstrate distinct characteristics from those with GH deficiency from other non-TBI causes in that their symptom complex improves significantly with recombinant human GH treatment, but does not reverse the underlying mechanistic cause as symptoms typically recur upon treatment cessation. Conclusion: The reviewed data describe the importance of alterations of the GH/insulin-like growth factor I axis and gut microbiome after brain injury and its influence in promoting neurocognitive and behavioral deficits in a bidirectional relationship, and highlight a new clinical syndrome that may exist in a subset of TBI patients in whom recombinant human GH therapy could significantly improve symptomatology. More studies are needed to further characterize this clinical syndrome.
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Studies indicate that the majority of children diagnosed with TBI-related GHD show onset of symptoms between 6 months and 2 years post-injury, with some cases taking longer.
“Studies indicate that the majority of children diagnosed with TBI-related GHD show onset of symptoms between 6 months and 2 years post-injury, with some cases taking longer to manifest [24,25,26,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [25]
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- Authors
- Yuen, K. C. J., Masel, B. E., Reifschneider, K. L., Sheffield-Moore, M., Urban, R. J., & Pyles, R. B.
- Affiliations
- Barrow Neurological Institute (US)
- Centre for Neuro Skills, Bakersfield, California
- Children's Specialty Group (US)
- Department of Health and Kinesiology, Texas A & M University, College Station, Texas
- The University of Texas Medical Branch at Galveston (US)
- Corresponding author
- Yuen, Kevin C J
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-06-25
- Volume
- 105
- Issue
- 9
- Pages
- e3054-e3064
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W3037240533
- Cited by
- 24
- References
- 110
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 4 · 2022: 4 · 2021: 5
- FWCI
- 0.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, growth hormone, insulin-like growth factor I, gut microbiota, hypopituitarism, recombinant human growth hormone therapy, neurocognitive impairment, fatigue, pituitary dysfunction, inflammation
- MeSH terms
- Gastrointestinal Microbiome, Brain Injuries, Traumatic, Humans, Hypopituitarism, Insulin-Like Growth Factor I, Syndrome, Signal Transduction, Treatment Outcome, Human Growth Hormone
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