Context
Traumatic brain injury (TBI) is considered the “signature” 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.
Objective
To report the experience of a pituitary clinic in screening for and diagnosis of pituitary dysfunction.
Design
Retrospective analysis.
Setting
U.S. tertiary care center.
Patients
Veterans referred to the VA Puget Sound Healthcare System pituitary clinic with a history of TBI at least 12 months prior.
Main Outcome Measures
Demographics, medical history, symptom burden, baseline hormonal evaluation, brain imaging, and provocative testing for adrenal insufficiency (AI) and adult-onset growth hormone deficiency (AGHD).
Results
Fatigue, cognitive/memory problems, insomnia, and post-traumatic 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 thirteen (22.4%) AI, twelve (20.7%) AGHD, two (3.4%) secondary hypogonadism, and five (8.6%) hyperprolactinemia diagnoses; there were no cases of thyroid-stimulating hormone deficiency.
Conclusions
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.
Described as the balance of values on either side of a moral dilemma, ethics and ethical issues are of increasing importance in the changing practice of rehabilitation medicine. Because the substance of ethics and true ethical issues can be difficult to identify, the education of rehabilitation residents in ethics can similarly be challenging. This article discusses topics pertinent to an understanding of clinical ethics in rehabilitation medicine and provides a method of teaching residents through an algorithm of ethical issues, learning objectives, and illustrative cases.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.