Cortisol Dynamics, Quality of Life, and Fatigue following Traumatic Brain Injury in Childhood
Authors' conclusion
Although not as prevalent as previously reported, HPA axis dysfunction does occur in survivors of childhood TBI, confirming the need for endocrine surveillance. However, in most of our paediatric TBI survivors assessed 7-11 years post-TBI, HPA function and circadian rhythmicity were preserved or had recovered. Chronic fatigue is a common concern post-TBI, but in the majority, it is not associated with frank HPA axis dysfunction. Morning salivary cortisone levels were higher in TBI survivors (who have a high prevalence of fatigue) compared to healthy controls, despite the recognised association of chronic fatigue with cortisol hyposecretion.
Study context
- Population
- Survivors of childhood traumatic brain injury (TBI) and matched controls; time post-TBI 6.8–10.8 years
- Participants
- 72 survivors
- Exposure
- Moderate/severe TBI vs mild TBI vs controls
- Moderate/severe TBIn = 31
- Mild TBIn = 24
- Controlsn = 17reference
- Outcome
- Long-term HPA axis function (cortisol/cortisone secretion, physiological and stimulated; HPA axis feedback) and associations with fatigue, depression and QoL
Methodological detailsmatched controls
- Matched controls
Main finding
As reported in the abstract
Peak cortisol <500 nmol/L on ITT
2 of 25
Peak cortisol <500 nmol/L on overnight serum profiles
9 of 22
Suboptimal ITT cortisol response in two participants, with low peak spontaneous serum levels
392 and 483 nmol/L; 227 and 447 nmol/L, respectively
Observational data: associations, not effects.
Further findings
Fatigue
- Fatigue in TBI participants
- 20/46
- Fatigue in controls
- 1/14
- Fatigue not associated with stimulated (ITT) or spontaneous (overnight profile) cortisol; one TBI participant with severe fatigue had a suboptimal ITT cortisol response
Quality of life (QoL)
- QoL attributes of health state (cognition, memory) impaired in TBI participants vs controls
Other pituitary function and imaging
- Hypogonadism in one female with moderate/severe TBI
- 1
- Normal thyroid and posterior pituitary function on baseline endocrine tests
- Pituitary neuroimaging normal in all participants
Original publication
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