Endocrine sequelae of traumatic brain injury in childhood

Anterior pituitary hormone dysfunction may be an important feature of long-term morbidity in survivors of traumatic brain injury (TBI). The hypothalamic-pituitary structures are vulnerable to damage following head injury. Therefore, pituitary dysfunction, which may be detected months or years after injury, is now well recognised as a long-term consequence of TBI in adults. In contrast, little is known about this potential complication in children and adolescents. This article reviews the available paediatric data, which show that hypopituitarism may occur after both mild and severe TBI, although there is little published data on its incidence or prevalence within this age group. A recent analysis of the KIGS (Pfizer International Growth Study database) highlights very few registered cases of TBI-related growth hormone deficiency, suggesting that this may be either an uncommon or an overlooked phenomenon. Prospective studies will be needed to determine the incidence, natural history and response to hormone replacement of post-TBI-induced hypopituitarism in children.

Given the critical role of anterior pituitary hormones in the regulation of growth and pubertal and neurocognitive development in childhood, early detection of hormone abnormalities is vital. A multidisciplinary approach to follow-up and endocrine assessment is required for the long-term management and rehabilitation of children and adolescents who survive moderate to severe head injury.