{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:26:08Z","timestamp":1783945568347,"version":"3.55.0"},"reference-count":109,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T00:00:00Z","timestamp":1593043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence Acquisition<\/jats:title>\n                  <jats:p>A review of studies in PubMed published between January 1980 to March 2020 and ongoing clinical trials was conducted using the search terms \u201cgrowth hormone,\u201d \u201ctraumatic brain injury,\u201d and \u201cgut microbiome.\u201d<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence Synthesis<\/jats:title>\n                  <jats:p>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 \u201cbrain injury associated fatigue and altered cognition.\u201d 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgaa398","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T16:53:47Z","timestamp":1593104027000},"page":"e3054-e3064","source":"Crossref","is-referenced-by-count":20,"title":["Alterations of the GH\/IGF-I Axis and Gut Microbiome after Traumatic Brain Injury: A New Clinical Syndrome?"],"prefix":"10.1210","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8169-2728","authenticated-orcid":false,"given":"Kevin C J","family":"Yuen","sequence":"first","affiliation":[{"name":"Barrow Pituitary Center, Barrow Neurological Institute and St. Joseph\u2019s Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent E","family":"Masel","sequence":"additional","affiliation":[{"name":"Centre for Neuro Skills, Bakersfield, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent L","family":"Reifschneider","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Children\u2019s Specialty Group, Children\u2019s Hospital of The King\u2019s Daughters, Norfolk, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda","family":"Sheffield-Moore","sequence":"additional","affiliation":[{"name":"Department of Health and Kinesiology, Texas A & M University, College Station, Texas"},{"name":"Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall J","family":"Urban","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 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