Prevalence of posttraumatic growth hormone deficiency is highly dependent on the diagnostic set-up: results from The Danish National Study on Posttraumatic Hypopituitarism
Open accessAbstract
CONTEXT: Recent international guidelines suggest pituitary screening in patients with moderate and severe traumatic brain injury (TBI). Predominantly isolated GH deficiency (GHD) was reported in the literature, raising the question of potential methodological bias. OBJECTIVE: Our objective was to assess the prevalence of GHD in patients admitted in 2008 with TBI, with concurrent assessment of methodological bias. DESIGN AND SETTING: We conducted a nationwide population-based cohort study at tertiary referral university hospitals. PARTICIPANTS: Participants were Danish patients with a head trauma diagnosis from the Danish Board of Health diagnostic code registry; 439 patients and 124 healthy controls underwent dynamic assessment of GH secretion 2.5 years (median) after TBI. MAIN OUTCOME: We evaluated the prevalence of GHD given use of 1) local versus guideline cutoffs, 2) insulin tolerance test (ITT), pyridostigmine (PD)-GHRH or GHRH-arginine (arg) test, 3) single versus repeated testing, and 4) GH assessment by assays with different isoform specificities. RESULTS: The prevalence of GHD was lower by local than by guideline cutoffs (12% vs 19% [PD-GHRH/GHRH-arg, P<.001]; 4.5% vs 5% [ITT, P=.9]), and by ITT than by PD-GHRH/GHRH-arg (P=.006 [local cutoffs]; P<.001 [guideline cutoffs]). Only 1% of patients had GHD according to 2 tests. GH assessment by the Immulite or iSYS assay caused no significant diagnostic differences. CONCLUSIONS: The study confirmed a high risk of bias in the management of pituitary testing of patients with TBI and stresses the importance of a proper control group and stringent GH testing including confirmatory testing in cohorts with low a priori likelihood of GHD such as in TBI. Our results question the evidence for newly introduced recommendations for routine pituitary assessment in TBI.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The prevalence of GHD defined by local cutoffs was 11.8%; when applying the national Danish criteria, incidence increased to 18.9%.
“The prevalence defined by local cutoffs was 11.8%; when applying the national Danish criteria, incidence increased to 18.9%.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [60]
The 'Impact of local vs guideline-derived cutoff values' section reports GHD prevalence of 11.8% with local cutoffs and 18.9% with guideline cutoffs, but only among patients assessed by a combined test; the ITT results were different. The 'Diagnostic criteria for GHD' and 'Diagnostic thresholds' sections identify the comparison cutoffs as drawn from international guidelines, not national Danish criteria. The paper also reports prevalence, not incidence. Page numbers were not available in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredThe incidence of GHD using insulin tolerance testing (local criteria ≤2.6, national criteria ≤3 mcg/L) was similar at 5%.
“In contrast, the incidence of GHD using Insulin tolerance testing (local criteria ≤2.6, national criteria of ≤3 mcg/L) was similar at 5%.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [60]
The 'Impact of local vs guideline-derived cutoff values' section reports GHD prevalence of 4.5% with the local ITT cutoff and 5.0% with the guideline cutoff. The 'Local cutoff values' and 'Diagnostic criteria' sections give those cutoffs as 2.6 and 3 µg/L. The figures support the comparison, but the paper reports prevalence, not incidence. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe PD-GHRH stimulation test is not commonly used in the diagnosis of adult GHD and is not well-standardized.
“The limitations of this study were that the PD-GHRH stimulation test is not a commonly used test in the diagnosis of adult GHD (21), and it is not well-standardized (22).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
The Diagnostic thresholds section (page unavailable) says definite BMI-related cutoffs for the PD-GHRH test are unavailable and that adapting cutoffs from another test was inappropriate, supporting the concern about standardization. The Methods section describes its use in this study, but the paper does not establish that PD-GHRH is uncommon in adult GHD diagnosis generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredFalse-positive results after GH testing occurred in 2-8% of controls, depending on the tests and cutoffs used.
“Additionally, Klose et al (21) showed that false-positive results after GH testing occurred in 2-8% of controls, depending on the tests and cutoffs used.”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
The 'Impact of local vs guideline-derived cutoff values' section reports false-positive GH-deficiency results in healthy controls that varied by test and cutoff. But it gives 4% for ITT and up to 20% for combined tests under guideline cutoffs, so the claimed 2–8% range is not supported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredComparing national and local criteria, the prevalence of GHD varied more using combined testing: insulin tolerance test (ITT); pyridostigmine-GHRH or GHRH-Arginine agents.
“Comparing national and local criteria, the prevalence of GHD varied more using combined testing: insulin tolerance test (ITT); pyridostigmine-GHRH or GHRH-Arginine agents.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [60]
In TBI patients, the prevalence of GH deficiency was lower by ITT than by PD-GHRH/GHRH+ARG testing.
“and by ITT than by PD-GHRH/GHRHϩARG (P ϭ .006[local cutoffs]; P Ͻ .001[guideline cutoffs]).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
Only 1% of TBI patients had GH deficiency according to two tests.
“Only 1% of patients had GHD according to two tests.”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
In TBI patients, the prevalence of GH deficiency was lower by local than by guideline cutoffs.
“The prevalence of GHD was found to be lower by local than by guideline cutoffs (12 vs 19% [PD-GHRH/GHRHϩARG, P Ͻ .001];4.5 vs 5% [ITT, P ϭ .9])”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
GH assessment by Immulite or Isys assay caused no significant diagnostic differences.
“GH assessment by Immulite or Isys assay caused no significant diagnostic differences.”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
A substantial number of false-positive GH test results were found in the control group.
“Moreover, they showed that a substantial number of false-positive results were found in the control group.”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
According to ITT results with local cutoffs and standard cutoffs, the pooled prevalence of GHD was 7.7% in patients and 1.4% in controls.
“According to the ITT results with local cutoffs used by Klose et al (21) and standard cutoffs used in the other studies, the pooled prevalence of GHD was 7.7 and 1.4% in patients and controls, respectively (two-sided P with 2 test Ͻ.001).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
Differences in the reported frequency of TBI-induced hypopituitarism may be due to more stringent diagnostic criteria applied by some studies but not others.
“Differences in the reported frequency of TBI-induced hypopituitarism may be due to more stringent diagnostic criteria being applied by some studies but not by others (21,194).”
From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [21]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Molitch, M. E., Clemmons, D. R., Malozowski, S., Merriam, G. R., & Vance, M. L. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0179 · Cited by 1,047 · see citing works
Use of Methodological Standards in Diagnostic Test Research
Reid, M. C. (1995) · JAMA · doi:10.1001/jama.274.8.645 · Cited by 705 · see citing works
; (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.83.2.379 · Cited by 655 · see citing works
Ho, K. K. Y., & _, _. (2007) · European Journal of Endocrinology · doi:10.1530/eje-07-0631 · Cited by 615 · see citing works
Schneider, H. J., Kreitschmann-Andermahr, I., Ghigo, E., Stalla, G. K., & Agha, A. (2007) · JAMA · doi:10.1001/jama.298.12.1429 · Cited by 549 · see citing works
Kelly, D. F., Gaw Gonzalo, I. T., Cohan, P., Berman, N., Swerdloff, R., & Wang, C. (2000) · Journal of Neurosurgery · doi:10.3171/jns.2000.93.5.0743 · Cited by 455 · see citing works
Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency
Biller, B. M. K., Samuels, M. H., Zagar, A., Cook, D. M., Arafah, B. M., Bonert, V., Stavrou, S., Kleinberg, D. L., Chipman, J. J., & Hartman, M. L. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.5.8509 · Cited by 423 · see citing works
Anterior Pituitary Dysfunction in Survivors of Traumatic Brain Injury
Agha, A., Rogers, B., Sherlock, M., O’Kelly, P., Tormey, W., Phillips, J., & Thompson, C. J. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0511 · Cited by 390 · cited 2× · see citing works
“Lower prevalence was anticipated upon confirmatory testing in keeping with the observation that studies using confirmatory tests in general reported lower prevalence of posttraumatic hypopituitarism (4, 10, 31).”
Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study
Aimaretti, G., Ambrosio, M. R., Di Somma, C., Gasperi, M., Cannavò, S., Scaroni, C., Fusco, A., Del Monte, P., De Menis, E., Faustini-Fustini, M., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0504 · Cited by 370 · see citing works
Clemmons, D. R. (2011) · Clinical Chemistry · doi:10.1373/clinchem.2010.150631 · Cited by 352 · see citing works
Occurrence of pituitary dysfunction following traumatic brain injury
Bondanelli, M., De Marinis, L., Ambrosio, M. R., Monesi, M., Valle, D., Zatelli, M. C., Fusco, A., Bianchi, A., Farneti, M., & Degli, E. C. I. (2004) · Journal of Neurotrauma · doi:10.1089/0897715041269713 · Cited by 322 · see citing works
Corneli, G., Somma, C. D., Baldelli, R., Rovere, S., Gasco, V., Croce, C. G., Grottoli, S., Maccario, M., Colao, A., Lombardi, G., et al. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01967 · Cited by 318 · see citing works
New approach to the diagnosis of growth hormone deficiency in adults
Ghigo, E., Aimaretti, G., Gianotti, L., Bellone, J., Arvat, E., & Camanni, F. (1996) · European Journal of Endocrinology · doi:10.1530/eje.0.1340352 · Cited by 257 · see citing works
Rasmussen, M. H., HVIDBERG, A. D., Juul, A., Main, K. M., Gotfredsen, A., Skakkebæk, N. E., Hilsted, J., & Skakkebae, N. E. (1995) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.80.4.7536210 · Cited by 248 · see citing works
Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury
Schneider, H. J., Schneider, M., Saller, B., Petersenn, S., Uhr, M., Husemann, B., von Rosen, F., & Stalla, G. K. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02071 · Cited by 224 · see citing works
Prevalence and predictive factors of post-traumatic hypopituitarism
Klose, M., Juul, A., Poulsgaard, L., Kosteljanetz, M., Brennum, J., & Feldt‐Rasmussen, U. (2007) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.02860.x · Cited by 176 · see citing works
Self-citationWilkinson, C. W., Pagulayan, K. F., Petrie, E. C., Mayer, C. L., Colasurdo, E. A., Shofer, J. B., Hart, K. L., Hoff, D., Tarabochia, M. A., & Peskind, E. R. (2012) · Frontiers in Neurology · doi:10.3389/fneur.2012.00011 · Cited by 162 · see citing works
Ghigo, E., GOFFI, S., Nicolosi, M., Arvat, E., Valente, F., Mazza, E., GHIGO, M. C., & Camanni, F. (1990) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-71-6-1481 · Cited by 161 · see citing works
Kokshoorn, N. E., Wassenaar, M. J. E., Biermasz, N. R., Roelfsema, F., Smit, J. W. A., Romijn, J. A., & Pereira, A. M. (2010) · European Journal of Endocrinology · doi:10.1530/eje-09-0601 · Cited by 129 · see citing works
Makimura, H., Stanley, T. L., Mun, D., You, S. M., & Grinspoon, S. K. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1333 · Cited by 117 · see citing works
Chronic Hypopituitarism after Traumatic Brain Injury
(2008) · Neurosurgery · doi:10.1227/01.neu.0000339459.86462.45 · Cited by 117 · see citing works
Predictors of anterior pituitary insufficiency after traumatic brain injury
Schneider, M., Schneider, H. J., Yassouridis, A., Saller, B., Von Rosen, F., & Stalla, G. K. (2008) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.03020.x · Cited by 107 · cited 2× · see citing works
“6) Waist 102 cm (men) or 88 cm (women), n (%) 119 (27) 22 (18) Tests performed, n (%) ITT (single test) 29 (7) 0 (0) PD-GHRH (single test) 200 (45) 4 (3) GHRH-arg (single test) 37 (8) 1 (1) ITT plus PD-GHRH 156 (36) 79 (64) ITT plus GHRH-arg 15 (3) 31 (25) ITT plus PD-GHRH plus GHRH-arg 0 (0) 9 (7)”
Cordido, F., Diéguez, C., & Casanueva, F. F. (1990) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-70-5-1361 · Cited by 104 · see citing works
Tanriverdi, F., Unluhizarci, K., & Kelestimur, F. (2010) · Pituitary · doi:10.1007/s11102-009-0215-x · Cited by 103 · see citing works
Hypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage
Klose, M., Brennum, J., Poulsgaard, L., Kosteljanetz, M., Wagner, A., & Feldt‐Rasmussen, U. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2010.03791.x · Cited by 81 · see citing works
Self-citationAutomated 22-kD Growth Hormone–Specific Assay without Interference from Pegvisomant
Manolopoulou, J., Alami, Y., Petersenn, S., Schopohl, J., Wu, Z., Strasburger, C. J., & Bidlingmaier, M. (2012) · Clinical Chemistry · doi:10.1373/clinchem.2012.188128 · Cited by 75 · see citing works
Colao, A., Somma, C. D., Savastano, S., Rota, F., Savanelli, M. C., Aimaretti, G., & Lombardi, G. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1134 · Cited by 68 · see citing works
Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study
Kokshoorn, N. E., Smit, J. W. A., Nieuwlaat, W. A., Tiemensma, J., Bisschop, P. H., Groote Veldman, R., Roelfsema, F., Franken, A. A. M., Wassenaar, M. J. E., Biermasz, N. R., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-11-0365 · Cited by 65 · see citing works
van der Eerden, A. W., Twickler, M. T. B., Sweep, F. C. G. J., Beems, T., Hendricks, H. T., Hermus, A. R. M. M., & Vos, P. E. (2010) · European Journal of Endocrinology · doi:10.1530/eje-09-0436 · Cited by 51 · see citing works
Hoeck, H. C., Jakobsen, P. E., Vestergaard, P., Falhof, J., & Laurberg, P. (1999) · Growth Hormone & IGF Research · doi:10.1054/ghir.1998.0085 · Cited by 49 · see citing works
Self-citationAndersen, M., Hansen, T. B., Staving, R. K., Bertelsen, J., Hangaard, J., Petersen, P. H., & Hagen, C. (1996) · University of Southern Denmark Research Portal (University of Southern Denmark) · Cited by 46 · see citing works
Self-citationGhigo, E., Mazza, E., Corrias, A., IMPERIALE, E., GOFFI, S., Arvat, E., BELLONE, J., Sanctis, C. D., Müller, E. E., & Camanni, F. (1989) · Metabolism · doi:10.1016/0026-0495(89)90099-1 · Cited by 43 · see citing works
Fisker, Jørgensen, Ørskov, & Christiansen (1998) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1998.00362.x · Cited by 41 · see citing works
How many tests are required to diagnose growth hormone (GH) deficiency in adults?
Lissett, C. A., Thompson, E. G. E., Rahim, A., Brennan, B. M. D., & Shalet, S. M. (1999) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1999.00836.x · Cited by 34 · see citing works
Gardner, C. J., Javadpour, M., Stoneley, C., Purthuran, M., Biswas, S., Daousi, C., MacFarlane, I. A., & Cuthbertson, D. J. (2012) · European Journal of Endocrinology · doi:10.1530/eje-12-0849 · Cited by 30 · see citing works
Massimo, P., Maccario, M., Savio, P., et al. (1998) · PubMed · Cited by 14 · see citing works
The pyridostigmine-growth-hormone-releasing-hormone test in adults
Andersen, M., Hansen, T. B., Støving, R. K., Bertelsen, J., Hangård, J., Petersen, P. H., & Hagen, C. (1996) · University of Southern Denmark Research Portal (University of Southern Denmark) · Cited by 13 · see citing works
Self-citationHypopituitarism is uncommon after aneurysmal subarachnoid haemorrhage
Hannon, M. J., & Thompson, C. J. (2010) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2010.03803.x · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach
Tanriverdi, F., Schneider, H. J., Aimaretti, G., Masel, B. E., Casanueva, F. F., & Kelestimur, F. (2015) · Endocrine Reviews · doi:10.1210/er.2014-1065 · Cited by 218 · see citing works
Tan, C. L., Alavi, S. A., Baldeweg, S. E., Belli, A., Carson, A., Feeney, C., Goldstone, A. P., Greenwood, R., Menon, D. K., Simpson, H. L., et al. (2017) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2016-315500 · Cited by 111 · see citing works
“29 Specifically, the prevalence of GHD was lower when using local, compared with guideline-defined cut-offs, while insulin tolerance testing yielded a lower prevalence of GHD compared with the pyridostigmine-growth hormone-releasing hormone (PD-GHRH) or GHRH-arginine test.”
MethodUpdate of Endocrine Dysfunction following Pediatric Traumatic Brain Injury
Reifschneider, K., Auble, B., & Rose, S. (2015) · Journal of Clinical Medicine · doi:10.3390/jcm4081536 · Cited by 66 · see citing works
Gardner, C. J., Mattsson, A. F., Daousi, C., Korbonits, M., Koltowska-Haggstrom, M., & Cuthbertson, D. J. (2015) · European Journal of Endocrinology · doi:10.1530/eje-14-0654 · Cited by 65 · see citing works
Tritos, N. A., Yuen, K. C. J., & Kelly, D. F. (2015) · Endocrine Practice · doi:10.4158/ep14567.dscr · Cited by 51 · see citing works
Krewer, C., Schneider, M., Schneider, H. J., Kreitschmann-Andermahr, I., Buchfelder, M., Faust, M., Berg, C., Wallaschofski, H., Renner, C., Uhl, E., et al. (2016) · Journal of Neurotrauma · doi:10.1089/neu.2015.4109 · Cited by 47 · see citing works
Personnier, C., Crosnier, H., Meyer, P., Chevignard, M., Flechtner, I., Boddaert, N., Breton, S., Mignot, C., Dassa, Y., Souberbielle, J.-C., et al. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-4129 · Cited by 43 · see citing works
Hypopituitarism after traumatic brain injury
Fernandez-Rodriguez, E., Bernabeu, I., Castro, A. I., & Casanueva, F. F. (2015) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2014.10.012 · Cited by 40 · see citing works
Alavi, S. A., Tan, C. L., Menon, D. K., Simpson, H. L., & Hutchinson, P. J. (2016) · British Journal of Neurosurgery · doi:10.3109/02688697.2015.1109060 · Cited by 35 · see citing works
Cuesta, M., Hannon, M. J., Crowley, R. K., Behan, L. A., Tormey, W., Rawluk, D., Delargy, M., Agha, A., & Thompson, C. J. (2016) · Clinical Endocrinology · doi:10.1111/cen.12874 · Cited by 29 · see citing works
Astradsson, A., Munck af Rosenschöld, P., Feldt-Rasmussen, U., Poulsgaard, L., Wiencke, A. K., Ohlhues, L., Engelholm, S. A., Broholm, H., Hansen Møller, E., Klose, M., et al. (2017) · Acta Oncologica · doi:10.1080/0284186x.2016.1270466 · Cited by 26 · see citing works
Self-citationYuen, K. C. J., Masel, B. E., Reifschneider, K. L., Sheffield-Moore, M., Urban, R. J., & Pyles, R. B. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa398 · Cited by 24 · see citing works
Less known aspects of central hypothyroidism: Part 1- Acquired etiologies
Benvenga, S., Klose, M., Vita, R., & Feldt-Rasmussen, U. (2018) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2018.09.003 · Cited by 19 · see citing works
Self-citationInteractions between hypothalamic pituitary thyroid axis and other pituitary dysfunctions
Feldt-Rasmussen, U., Klose, M., & Benvenga, S. (2018) · Endocrine · doi:10.1007/s12020-018-1738-6 · Cited by 12 · see citing works
Self-citation
- Authors
- Klose, M., Stochholm, K., Janukonyté, J., Lehman Christensen, L., Frystyk, J., Andersen, M., Laurberg, P., Christiansen, J. S., & Feldt-Rasmussen, U.
- Affiliations
- Aalborg University Hospital (DK)
- Aarhus University Hospital (DK)
- University of Southern Denmark (DK)
- Corresponding author
- Klose, Marianne
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-01
- Volume
- 99
- Issue
- 1
- Pages
- 101-110
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2066340447
- Cited by
- 73
- References
- 38
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 2 · 2022: 5 · 2021: 5 · 2020: 1 · 2019: 6 · 2018: 7 · 2017: 9 · 2016: 5 · 2015: 19 · 2014: 6 · 2013: 1
- FWCI
- 8.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Funders
- Gentofte Hospital
- Lundbeckfonden
- Novo Nordisk
- Rigshospitalet
- Region Hovedstaden
- A.P. Møller og Hustru Chastine Mc-Kinney Møllers Fond til almene Formaal
- H. Lundbeck A/S
- Fonden til Lægevidenskabens Fremme
- 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, insulin tolerance test, GHRH-arginine test, diagnostic thresholds, methodological bias, prevalence
- MeSH terms
- Adolescent, Adult, Aged, Brain Injuries, Denmark, Diagnostic Techniques, Endocrine, Female, Humans, Hypopituitarism, Male, Middle Aged, Prevalence, Case-Control Studies, Human Growth Hormone, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
