Brain Injury Clinical Trial
OBJECTIVES:
I. Determine the incidence of neuroendocrine dysfunction in patients with closed head
injuries admitted to the Transitional Learning Community in Galveston, Texas, for
rehabilitation.
PROTOCOL OUTLINE: Phase I: Patients undergo fasting for urine and blood endocrine
assessments. First morning urine is collected for measurement of 6-sulphatoxymelatonin
(6-SMT). Following a medical history and a physical examination, patients undergo
measurement of serum levels of free thyroxine, thyroid stimulating hormone (TSH), prolactin,
insulin-like growth factor I (IGF-I), dehydroepiandrosterone-sulfate (DHEA-S), free and
total testosterone (males only), and baseline growth hormone (GH). Female patients also
provide a menstrual history and undergo screening for hypogonadism. Patients then undergo GH
stimulation testing comprised of measurement of serum GH levels before and on 6 occasions
during the 3 hours after receiving glucagon IV.
After eating, patients undergo adrenocorticotropic hormone stimulation testing comprised of
measurement of serum cortisol levels before and at 45 minutes after receiving corticotropin
IV.
Phase II: Beginning at noon on a different day, patients with any abnormal endocrine tests
during phase I undergo 24 hour inpatient dynamic testing of the neuroendocrine system.
Patients undergo GH stimulation testing comprised of measurement of serum GH levels before
and on 4 occasions during the 2 hours after receiving levodopa. Patients also undergo
concurrent thyrotropin releasing hormone (TRH) and gonadotropin releasing hormone (GnRH)
stimulation testing comprised of measurement of serum TSH and luteinizing hormone (LH)
levels before and at 15, 30, 60, and 90 minutes after receiving TRH and GnRH IV. Patients
then undergo overnight metyrapone testing comprised of baseline measurement of serum
11-deoxycortisol and cortisol levels, followed by oral metyrapone with a snack, overnight
fasting, and then remeasurement of serum 11-deoxycortisol and cortisol levels.
;
Primary Purpose: Screening
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