FRI340 Growth Hormone Deficiency Post Carbon Monoxide Poisoning
Authors: Ghamlouche Ahmad Yehia , Alzohaili Opada , Elkadry Ayman Hussein 
Published: October 2023

Abstract
Disclosure: A.Y. Ghamlouche: None. O. Alzohaili: None. A.H. Elkadry: None.
Carbon monoxide (CO) is the poisonous byproduct of combustion of fossil fuels, that is odorless and tasteless. In toxic levels CO leads to the impaired functioning of red blood cell’s ability to transport oxygen to tissues.1 Following CO toxicity, white matter demyelination and necrosis of the Globus pallidus that further results in other neurologic disorders, is common.2 A novel and underrecognized consequence of CO poisoning is growth hormone deficiency (GHD). GHD is the most common pituitary hormone deficiency following a traumatic brain injury.3 Four cases of GHD were described following an event of CO poisoning. Recommended GHD diagnosis criteria of less than 5.0 ng/mL was used with these patients. The Insulin Tolerance Test (ITT) and Glucagon stimulation test (GST) were administered. All patients had no causes of GHD in their medical history prior to their encounters with CO poisoning. A 44-year-old male with exposure in 2020, came for an evaluation in January of 2022 complaining of memory impairment, brain fog, mental fatigue, cognitive decline, anxiety, poor libido, and neuropathy. showed a GH peak of 1.1 ng/mL during the ITT a peak of 1.0 ng/mL during the GST. A 51-year-old male with exposure in 2016, came for an evaluation in December of 2020 complaining of memory impairment, blurry vision, fatigue, physical weakness, mood changes, and stuttered speech. Results showed a GH peak of 4.4 ng/mL during ITT and a GH peak of 0.157 ng/mL during the GST.A 43-year-old female with exposure in 2017, came for an evaluation in January of 2022 complaining of memory loss, attention issues, anxiety, depression, fatigue, weight gain and neuropathy. Results showed a GH peak of 1.7 ng/mL during ITT and a GH peak of 2.6 ng/mL during the GST. A 42-year-old male with exposure in 2018, came for an evaluation in November of 2019 complaining of memory impairment, headaches, tremors, fatigue, anxiety, depression, declining cognition, insomnia, poor libido, lack of concentration, and poor vision. Results showed a GH peak of 3.6 ng/mL during ITT and a GH peak of 0.109 ng/mL during the GST. All 4 patients were started on GH replacement therapy following their tests. All patients responded well, and showed significant improvements in quality of life. A possible connection can be drawn between pituitary gland damage and hypoxia from CO poisoning. References: 1. Brown S.D., Piantadosi C.A. Reversal of carbon monoxide-cytochrome c oxidase binding by hyperbaric oxygen in vivo. Adv Exp Med Biol. 1989;248:747–754. 2.Mazo J, Mukhtar E, Mazo Y, Nagaraj A, Mantello MT. Delayed brain injury post carbon monoxide poisoning. Radiol Case Rep. 2020;15(10):1845-1848. Published 2020 Aug 10. doi:10.1016/j.radcr.2020.07.048. 3. Kgosidialwa O, Hakami O, Muhammad Zia-Ul-Hussnain H, Agha A. Growth Hormone Deficiency Following Traumatic Brain Injury. Int J Mol Sci. 2019;20(13):3323. Published 2019 Jul 6. doi:10.3390/ijms20133323
Presentation: Friday, June 16, 2023