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Sent once a day, and only if the couple hit it off, and one of the best-kept secret. Seem to me that men might like her for all the good. Healthy adults aged 40 to 65 years were not included in the study, whereas some above the age of 65 displayed low GH responses. In the present study, only individuals below the age of 65 years were included.

However, this issue merits further investigation. Lower prevalence was anticipated upon confirmatory testing in keeping with the observation that studies using confirmatory tests in general reported lower prevalence of posttraumatic hypopituitarism 4 , 10 , Previous guidelines recommended 2 abnormal GH tests to establish the diagnosis of isolated adult-onset GHD, whereas 1 test was sufficient in cases of additional pituitary deficiencies 32 , 33 , illustrating that the diagnostic accuracy is dependent on the patient population studied This requirement of confirmatory testing has been omitted in recent guidelines.

Furthermore, moderate and severe TBI, and aneurysmal subarachnoid hemorrhage were added to conditions where GH testing and treatment should be considered 2 , 3. Their entrance into the guidelines was based on evidence from studies mainly performing single testing and included studies not using currently required BMI-stratified cutoffs. Given the present data and those from other very recent studies also using more stringent diagnostic criteria 8 , 10 , 35 , 36 , the evidence for including TBI and SAH has been weakened and the indication for routine GH and pituitary assessment in these patient populations needs reconsideration.

Patients were recruited from the national background TBI population and, thus, included fewer patients with moderate to severe TBI than most of the original studies.


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In the present study, GHD was unrelated to trauma severity, and different distribution of TBI severity was thus unlikely to cause significant bias. Although baseline data were available for all patients, outcome measures were unavailable for nonparticipants. A weakness of the present study, and studies in general where inclusion depends on the patient's wish to participate, was lack of background and outcome information from nonparticipants. Thus, whether nonparticipants matched participants to a degree allowing for extrapolation to the general background population remains largely unknown.

Although planned as unselected, included patients were older with more severe TBI as compared with nonparticipants. Such selection bias may ultimately result in a prevalence of posttraumatic GHD different from an otherwise eligible background TBI population. Given the previous identification of trauma severity as predictor of posttraumatic hypopituitarism 4 — 7 , the present results more likely overestimated than underestimated the true prevalence.

A low prevalence of posttraumatic hypopituitarism was demonstrated in an a priori unselected TBI population by applying stringent criteria including confirmatory testing.


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The prevalence was, however, highly dependent upon management of testing for GHD, and the study confirmed a high risk of bias in pituitary testing of patients with TBI. The results stress the importance of a proper control group and stringent GH testing, particularly in cohorts with a low a priori likelihood of GHD such as TBI. Based on our data, together with data from other more recent studies, also supporting a lower prevalence than observed in the original studies, general recommendations concerning testing for hypopituitarism in TBI should be considered premature.

Immunodiagnostic Systems provided iSYS GH kits free of charge but had no influence on results or their interpretation. The study received an unrestricted grant from Novo Nordisk, and Immunodiagnostic Systems provided iSYS GH kits free of charge, but had no influence on results or their interpretation.

The authors have nothing else to declare. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Patients and Methods

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FPR, false-positive rate in healthy controls by application of guideline cutoffs. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: Evaluation and treatment of adult growth hormone deficiency: Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: Predictors of anterior pituitary insufficiency after traumatic brain injury. Low prevalence of hypopituitarism after traumatic brain injury: Chronic hypopituitarism after traumatic brain injury: Should anterior pituitary function be tested during follow-up of all patients presenting at the emergency department because of traumatic brain injury?

High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Pituitary function in subjects with mild traumatic brain injury: Differences in reproducibility and peak growth hormone responses to repeated testing with various stimulators in healthy adults. Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Automated kD growth hormone-specific assay without interference from Pegvisomant. The cutoff limits of the GH response to GH-releasing hormone-arginine test related to body mass index.

GH response to GHRH combined with pyridostigmine or arginine in different conditions of low somatotrope secretion in adulthood: The pyridostigmine-growth-hormone-releasing-hormone test in adults. The reference interval and A Comparison with the insulin tolerance test. The effects of central adiposity on growth hormone GH response to GH-releasing hormone-arginine stimulation testing in men. A reappraisal of diagnosing GH deficiency in adults: Effect of central cholinergic neurotransmission enhancement by pyridostigmine on the growth hormone secretion elicited by clonidine, arginine, or hypoglycemia in normal and obese subjects.

Massive weight loss restores hour growth hormone release profiles and serum insulin-like growth factor-I levels in obese subjects.

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Effect of cholinergic enhancement by pyridostigmine on growth hormone secretion in obese adults and children. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency.

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