The effects of head trauma on hypothalamic-pituitary function in children and adolescents
Silvia Einaudi1, Claudia Bondone
1Department of Pediatric Endocrinology, Regina Margherita Hospital, Turin, Italy. silvein@libero.it
Insights
Traumatic brain injury (TBI) can cause significant endocrine dysfunctions in children, including adrenal insufficiency and electrolyte imbalances. Long-term monitoring for hypopituitarism is crucial for growth and pubertal development after TBI.
Area of Science:
- Pediatric endocrinology
- Neurotraumatology
- Pediatric critical care
Background:
- Traumatic brain injury (TBI) is increasingly linked to endocrine dysfunctions.
- Concerns exist regarding TBI's endocrine impact on pediatric populations.
- This review focuses on acute dysfunction and hypopituitarism in pediatric TBI.
Purpose of the Study:
- To review recent findings on acute endocrine dysfunction after pediatric TBI.
- To summarize current knowledge on TBI-associated hypopituitarism in children and adolescents.
Main Methods:
- Review of the pediatric literature.
- Summary of recent findings on acute-phase dysfunction.
- Analysis of data on TBI-associated hypopituitarism.
Main Results:
- Pathophysiology of acute hyponatremic and hypernatremic disorders elucidated.
- Ongoing prospective studies on pediatric TBI-associated hypopituitarism.
- Preliminary data available from ongoing studies.
Conclusions:
- TBI causes endocrine dysfunctions in 28-69% of adult patients.
- Adrenal insufficiency and electrolyte disorders are critical acute post-TBI conditions.
- Hypopituitarism may manifest years after TBI; growth hormone and gonadotropin deficiencies are common, necessitating follow-up.
Purpose Of Review:
Endocrine dysfunctions have been increasingly recognized following traumatic brain injury. Ever more numerous studies on acute head-injured adults have also raised concern about this risk in children and adolescents who have experienced head injury. The current review of the pediatric literature summarizes recent findings on acute-phase dysfunction and traumatic brain injury-associated hypopituitarism.
Recent Findings:
The pathophysiologic mechanisms underlying acute-phase hyponatremic and hypernatremic disorders have been elucidated. Prospective studies on traumatic brain injury-associated hypopituitarism in pediatric patients are ongoing and preliminary data are available.
Summary:
Traumatic brain injury, a 'silent epidemic' that carries a considerable burden of disabilities, leads to a variety of endocrine dysfunctions in 28-69% of adult acute head-injured patients. In the acute posttraumatic phase, adrenal insufficiency and electrolyte disorders are critical conditions. Neurosurgical patients, particularly those prone to neurological damage, require prompt diagnosis. Hypopituitarism may be diagnosed months or years after a traumatic brain injury event. Since growth hormone and gonadotropin secretion are most frequently compromised, careful follow-up of growth and pubertal development is mandatory in children hospitalized for traumatic brain injury.
Related Concept Videos
01:28Traumatic Brain Injury l: Introduction
01:37Hypothalamic-Pituitary Axis