Metabolic and QOL Effects of GH Treatment in Patients With TBI and AGHD

Inclusion Criteria: 1. OEF/OIF/OND deployment confirmed by available records 2. history of combat exposure during deployment as determined by a score greater than 1 on the Combat Experiences sub-scale of the Deployment Risk and Resilience Inventory-2 (DRRI-2) 3. age \>18 years 4. a history of TBI defined according to the DoD/VA guidelines and characterized by the Ohio State TBI Inventory 5. history of AGH deficiency diagnosed by: a) a GH stimulatory test; or b) low plasma IGF-1 level and 3 pituitary hormone deficiencies 6. have been prescribed rhGH replacement by a clinical provider 7. If the Veteran is receiving psychotropic medications he should be on stable doses for at least 4 weeks before their enrollment in the study. Exclusion Criteria: 1. Other untreated pituitary deficiencies \[patients with other hormone deficiencies will have to be on stable replacement for at least three months before including them on the study; two months of stable replacement is required for hydrocortisone therapy for adrenal insufficiency\] 2. tumors, or other causes of AGHD (e.g. childhood onset GHD, pituitary surgery, tumors, radiation) 3. history of neurologic or psychiatric disorder such as stroke, spinal cord injury, bipolar disorder, or schizophrenia that has a significant impact in the Veteran's functional status and QoL 4. contraindication to rhGH therapy (e.g. hypersensitivity to rhGH or any of the components of the supplied product, including metacresol, glycerin, or benzyl alcohol) 5. acute medical illness, active infection, neoplastic disease or decompensated chronic medical illness such as diabetes mellitus (A1c \>9%), congestive heart failure or chronic obstructive pulmonary disease 6. evidence of alcohol dependence, alcohol abuse or drug use disorder during the three months previous to enrollment in the study 7. evidence of inadequate levels of effort in performing neuropsychological tests as suggested by scoring less than 41 on Trial I of the Test of Memory and Malingering (TOMM) 8. due to the decreased specificity of the AGHD diagnostic tests in this setting and weight/size limitations of the DEXA scanner, we will exclude morbid obese subjects defined as having a BMI greater than 35 or body weight \> 350 lbs 9. use of rhGH in the previous 6 months 10. active or recent (6 months) history of coronary artery or cerebrovascular disease