Growth hormone deficiency after moderate traumatic brain injury with normal (or high) IGF-1; a case report demonstrating benefit of replacement therapy and clinical pearls for diagnosis.
Bryson J Hewins, Rachael D C Jones, Megan E Glazer et al.
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Case in brief
A patient developed persistent symptoms after moderate traumatic brain injury and was ultimately diagnosed with growth hormone deficiency. Screening laboratory results were inconclusive, despite clinical concern; definitive provocative testing supported the diagnosis. Growth hormone replacement was followed by significant improvement in debilitating fatigue, metabolic health, and specific domains of neurocognition. The report highlights that diagnosis may be delayed because symptoms overlap with chronic TBI effects and screening tests are unreliable, but targeted treatment may still be beneficial when deficiency is identified late.
What made this case unusual
Growth hormone deficiency was diagnosed despite normal or high IGF-1, illustrating that this screening result did not exclude deficiency in the case.
Diagnostic / clinical pearl
In persistently symptomatic patients after TBI, do not let inconclusive screening results override clinical suspicion; refer for definitive provocative testing.
Why it matters
The case suggests that recognizing post-TBI growth hormone deficiency, even years after injury, may identify a treatable contributor to fatigue and cognitive difficulties.