{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T02:50:15Z","timestamp":1771210215971,"version":"3.50.1"},"reference-count":43,"publisher":"The Endocrine Society","issue":"4","funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["BX002807"],"award-info":[{"award-number":["BX002807"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Traumatic brain injury (TBI) is considered the \u201csignature\u201d injury of veterans returning from wartime conflicts in Iraq and Afghanistan. While moderate\/severe TBI is associated with pituitary dysfunction, this association has not been well established in the military setting and in mild TBI (mTBI). Screening for pituitary dysfunction resulting from TBI in veteran populations is inconsistent across Veterans Affairs (VA) institutions, and such dysfunction often goes unrecognized and untreated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This work aims to report the experience of a pituitary clinic in screening for and diagnosis of pituitary dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective analysis was conducted in a US tertiary care center of veterans referred to the VA Puget Sound Healthcare System pituitary clinic with a history of TBI at least 12 months prior. Main outcome measures included demographics, medical history, symptom burden, baseline hormonal evaluation, brain imaging, and provocative testing for adrenal insufficiency (AI) and adult-onset growth hormone deficiency (AGHD).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fatigue, cognitive\/memory problems, insomnia, and posttraumatic stress disorder were reported in at least two-thirds of the 58 patients evaluated. Twenty-two (37.9%) were diagnosed with at least one pituitary hormone deficiency, including 13 (22.4%) AI, 12 (20.7%) AGHD, 2 (3.4%) secondary hypogonadism, and 5 (8.6%) hyperprolactinemia diagnoses; there were no cases of thyrotropin deficiency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A high prevalence of chronic AI and AGHD was observed among veterans with TBI. Prospective, larger studies are needed to confirm these results and determine the effects of hormone replacement on long-term outcomes in this setting.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jendso\/bvab005","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T18:44:14Z","timestamp":1611600254000},"source":"Crossref","is-referenced-by-count":15,"title":["Experience of a Pituitary Clinic for US Military Veterans With Traumatic Brain Injury"],"prefix":"10.1210","volume":"5","author":[{"given":"Jonathan","family":"Lee","sequence":"first","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3810-2427","authenticated-orcid":false,"given":"Lindsey J","family":"Anderson","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorota","family":"Migula","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin C J","family":"Yuen","sequence":"additional","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, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"McPeak","sequence":"additional","affiliation":[{"name":"Center for Polytrauma Care, Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4245-1753","authenticated-orcid":false,"given":"Jose M","family":"Garcia","sequence":"additional","affiliation":[{"name":"Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"2021121113523057100_CIT0001","article-title":"Comprehensive policy on traumatic brain injury-related neurocognitive assessments by the military services","author":"649013 DI","year":"2015"},{"key":"2021121113523057100_CIT0002","article-title":"DoD worldwide numbers for traumatic brain injury","author":"Defense and Veterans Brain Injury Center"},{"key":"2021121113523057100_CIT0003","author":"Summerall","year":"2018"},{"issue":"5","key":"2021121113523057100_CIT0004","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1056\/NEJMoa072972","article-title":"Mild traumatic brain injury in U.S. soldiers returning from Iraq","volume":"358","author":"Hoge","year":"2008","journal-title":"N Engl J Med."},{"issue":"2","key":"2021121113523057100_CIT0005","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1210\/jcem.83.2.4594","article-title":"Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee","volume":"83","author":"Carroll","year":"1998","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021121113523057100_CIT0006","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1089\/neu.2018.6349","article-title":"Prevalence of anterior pituitary dysfunction twelve months or more following traumatic brain injury in adults: a systematic review and meta-analysis","volume":"37","author":"Emelifeonwu","year":"2020","journal-title":"J Neurotrauma."},{"key":"2021121113523057100_CIT0007","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3389\/fneur.2018.00072","article-title":"Chronic hypopituitarism associated with increased postconcussive symptoms is prevalent after blast-induced mild traumatic brain injury","volume":"9","author":"Undurti","year":"2018","journal-title":"Front Neurol."},{"issue":"4","key":"2021121113523057100_CIT0008","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s11102-014-0606-5","article-title":"Growth hormone deficiency after mild combat-related traumatic brain injury","volume":"18","author":"Ioachimescu","year":"2015","journal-title":"Pituitary."},{"key":"2021121113523057100_CIT0009","article-title":"VA\/DoD clinical practice guideline for the management of concussion-mild traumatic brain injury","author":"Bowles","year":"2016"},{"issue":"23","key":"2021121113523057100_CIT0010","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1089\/neu.2014.3415","article-title":"Effects of subconcussive head trauma on the default mode network of the brain","volume":"31","author":"Johnson","year":"2014","journal-title":"J Neurotrauma."},{"key":"2021121113523057100_CIT0011","volume-title":"Management of Concussion-Mild Traumatic Brain Injury (mTBI)","author":"Veterans Affairs","year":"2016"},{"key":"2021121113523057100_CIT0012","first-page":"1587","article-title":"Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline","volume-title":"J Clin Endocrinol Metab.","author":"Molitch","year":"2011"},{"issue":"10","key":"2021121113523057100_CIT0013","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.4158\/EP161407.DSCR","article-title":"American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: update on growth hormone stimulation testing and proposed revised cut-point for the glucagon stimulation test in the diagnosis of adult growth hormone deficiency","volume":"22","author":"Yuen","year":"2016","journal-title":"Endocr Pract."},{"issue":"4","key":"2021121113523057100_CIT0014","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1373\/clinchem.2010.150631","article-title":"Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays","volume":"57","author":"Clemmons","year":"2011","journal-title":"Clin Chem."},{"issue":"8","key":"2021121113523057100_CIT0015","doi-asserted-by":"crossref","first-page":"3684","DOI":"10.1210\/jc.2010-0295","article-title":"Comparative validation of the growth hormone-releasing hormone and arginine test for the diagnosis of adult growth hormone deficiency using a growth hormone assay conforming to recent international recommendations","volume":"95","author":"Chanson","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"issue":"8","key":"2021121113523057100_CIT0016","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1210\/jc.2018-00665","article-title":"Macimorelin as a diagnostic test for adult GH deficiency","volume":"103","author":"Garcia","year":"2018","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"2021121113523057100_CIT0017","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1210\/jcem.87.5.8509","article-title":"Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency","volume":"87","author":"Biller","year":"2002","journal-title":"J Clin Endocrinol Metab."},{"issue":"12","key":"2021121113523057100_CIT0018","doi-asserted-by":"crossref","first-page":"4712","DOI":"10.1210\/jc.2014-2830","article-title":"Overweight\/Obese adults with pituitary disorders require lower peak growth hormone cutoff values on glucagon stimulation testing to avoid overdiagnosis of growth hormone deficiency","volume":"99","author":"Dichtel","year":"2014","journal-title":"J Clin Endocrinol Metab."},{"issue":"11","key":"2021121113523057100_CIT0019","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.4158\/GL-2019-0405","article-title":"American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of growth hormone deficiency in adults and patients transitioning from pediatric to adult care","volume":"25","author":"Yuen","year":"2019","journal-title":"Endocr Pract."},{"issue":"7","key":"2021121113523057100_CIT0020","first-page":"2350","article-title":"Evaluation of the integrity of the hypothalamic-pituitary-adrenal axis by insulin hypoglycemia test","volume":"83","author":"Erturk","year":"1998","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"2021121113523057100_CIT0021","first-page":"3713","article-title":"A comparison between the 1-\u03bcg adrenocorticotropin (ACTH) test, the short ACTH (250 \u03bcg) test, and the insulin tolerance test in the assessment of hypothalamo-pituitary-adrenal axis immediately after pituitary surgery","volume":"85","author":"D\u00f6kmeta\u015f","year":"2000","journal-title":"J Clin Endocrinol Metab."},{"issue":"4","key":"2021121113523057100_CIT0022","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1210\/jcem-72-4-773","article-title":"Adrenocorticotropin stimulation test: effects of basal cortisol level, time of day, and suggested new sensitive low dose test","volume":"72","author":"Dickstein","year":"1991","journal-title":"J Clin Endocrinol Metab."},{"issue":"11","key":"2021121113523057100_CIT0023","doi-asserted-by":"crossref","first-page":"3888","DOI":"10.1210\/jc.2016-2118","article-title":"Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline","volume":"101","author":"Fleseriu","year":"2016","journal-title":"J Clin Endocrinol Metab."},{"issue":"2","key":"2021121113523057100_CIT0024","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2265.1987.tb00780.x","article-title":"Value of basal plasma cortisol assays in the assessment of pituitary-adrenal insufficiency","volume":"26","author":"H\u00e4gg","year":"1987","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"3","key":"2021121113523057100_CIT0025","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1007\/s11102-016-0712-7","article-title":"Revised GH and cortisol cut-points for the glucagon stimulation test in the evaluation of GH and hypothalamic-pituitary-adrenal axes in adults: results from a prospective randomized multicenter study","volume":"19","author":"Hamrahian","year":"2016","journal-title":"Pituitary."},{"issue":"7","key":"2021121113523057100_CIT0026","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.3390\/jcm4071480","article-title":"Hypopituitarism in traumatic brain injury\u2014a critical note","volume":"4","author":"Klose","year":"2015","journal-title":"J Clin Med."},{"key":"2021121113523057100_CIT0027","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3389\/fneur.2012.00011","article-title":"High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury","volume":"3","author":"Wilkinson","year":"2012","journal-title":"Front Neurol."},{"issue":"6","key":"2021121113523057100_CIT0028","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1530\/EJE-11-0476","article-title":"The accuracy of diagnostic tests for GH deficiency in adults: a systematic review and meta-analysis","volume":"165","author":"Hazem","year":"2011","journal-title":"Eur J Endocrinol."},{"issue":"3","key":"2021121113523057100_CIT0029","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s11102-019-00938-y","article-title":"The frequency and the diagnosis of pituitary dysfunction after traumatic brain injury","volume":"22","author":"Glynn","year":"2019","journal-title":"Pituitary."},{"issue":"12","key":"2021121113523057100_CIT0030","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1001\/jama.298.12.1429","article-title":"Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review","volume":"298","author":"Schneider","year":"2007","journal-title":"JAMA."},{"issue":"2","key":"2021121113523057100_CIT0031","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/brain\/awx350","article-title":"Concussion, microvascular injury, and early tauopathy in young athletes after impact head injury and an impact concussion mouse model","volume":"141","author":"Tagge","year":"2018","journal-title":"Brain."},{"key":"2021121113523057100_CIT0032","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1227\/01.neu.0000325870.60129.6a","article-title":"Chronic hypopituitarism after traumatic brain injury: risk assessment and relationship to outcome","volume":"62","author":"Bavisetty","year":"2008","journal-title":"Neurosurgery."},{"issue":"6","key":"2021121113523057100_CIT0033","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1089\/neu.2006.23.928","article-title":"Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury","volume":"23","author":"Kelly","year":"2006","journal-title":"J Neurotrauma."},{"issue":"11","key":"2021121113523057100_CIT0034","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1007\/BF03345308","article-title":"Hypopituitarism as a consequence of traumatic brain injury (TBI) and its possible relation with cognitive disabilities and mental distress","volume":"27","author":"Popovic","year":"2004","journal-title":"J Endocrinol Invest."},{"issue":"4","key":"2021121113523057100_CIT0035","doi-asserted-by":"crossref","first-page":"443","DOI":"10.3803\/EnM.2015.30.4.443","article-title":"Diagnosis and treatment of hypopituitarism","volume":"30","author":"Kim","year":"2015","journal-title":"Endocrinol Metab (Seoul)."},{"issue":"4","key":"2021121113523057100_CIT0036","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1530\/eje.1.01873","article-title":"Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement","volume":"152","author":"Maghnie","year":"2005","journal-title":"Eur J Endocrinol."},{"issue":"1","key":"2021121113523057100_CIT0037","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12902-018-0247-1","article-title":"Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion","volume":"18","author":"Lithgow","year":"2018","journal-title":"BMC Endocr Disord."},{"issue":"1","key":"2021121113523057100_CIT0038","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1210\/jc.2013-2397","article-title":"Prevalence of posttraumatic growth hormone deficiency is highly dependent on the diagnostic set-up: results from the Danish National Study on Posttraumatic Hypopituitarism","volume":"99","author":"Klose","year":"2014","journal-title":"J Clin Endocrinol Metab."},{"issue":"6","key":"2021121113523057100_CIT0039","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1210\/jc.2011-0179","article-title":"Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline","volume":"96","author":"Molitch","year":"2011","journal-title":"J Clin Endocrinol Metab."},{"issue":"3","key":"2021121113523057100_CIT0040","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1385\/NCC:5:3:176","article-title":"Hemodynamic steroid responsiveness is predictive of neurological outcome after traumatic brain injury","volume":"5","author":"Bernard","year":"2006","journal-title":"Neurocrit Care."},{"key":"2021121113523057100_CIT0041","doi-asserted-by":"crossref","first-page":"520","DOI":"10.3389\/fendo.2018.00520","article-title":"Phase 2 randomized, placebo-controlled clinical trial of recombinant human growth hormone (rhGH) during rehabilitation from traumatic brain injury","volume":"9","author":"Dubiel","year":"2018","journal-title":"Front Endocrinol (Lausanne)."},{"issue":"4","key":"2021121113523057100_CIT0042","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1089\/neu.2016.4552","article-title":"Functional changes after recombinant human growth hormone replacement in patients with chronic traumatic brain injury and abnormal growth hormone secretion","volume":"34","author":"Mossberg","year":"2017","journal-title":"J Neurotrauma."},{"issue":"8","key":"2021121113523057100_CIT0043","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1089\/neu.2019.6690","article-title":"Growth hormone alters brain morphometry, connectivity, and behavior in subjects with fatigue after mild traumatic brain injury","volume":"37","author":"Wright","year":"2020","journal-title":"J Neurotrauma."}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jes\/advance-article-pdf\/doi\/10.1210\/jendso\/bvab005\/36094136\/bvab005.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/5\/4\/bvab005\/41725494\/bvab005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/5\/4\/bvab005\/41725494\/bvab005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T13:53:06Z","timestamp":1639230786000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvab005\/6118650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,25]]},"references-count":43,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvab005","relation":{},"ISSN":["2472-1972"],"issn-type":[{"value":"2472-1972","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,1]]},"published":{"date-parts":[[2021,1,25]]},"article-number":"bvab005"}}