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Published on: January 20, 2023
Evaluation of pituitary function after traumatic brain injury in childhood
Sophie N Khadr1, Patricia M Crofton, Patricia A Jones
1Section of Child Life & Health, University of Edinburgh Royal Hospital for Sick Children, Edinburgh, UK. s.khadr@ich.ucl.ac.uk
Insights
This study found no clinically significant pituitary dysfunction in childhood traumatic brain injury (TBI) survivors, despite some minor hormone abnormalities. These findings suggest TBI in children does not typically lead to long-term endocrine issues.
Area of Science:
- Pediatric endocrinology
- Neuroendocrinology
- Traumatic Brain Injury (TBI) research
Background:
- Post-traumatic hypopituitarism is a known complication in adult TBI survivors.
- The endocrine consequences of childhood TBI are less understood.
- Assessing pituitary function is crucial for long-term health outcomes in pediatric TBI.
Purpose of the Study:
- To investigate the prevalence and clinical significance of pituitary dysfunction in children following head injury.
- To evaluate the long-term endocrine health of childhood TBI survivors.
- To identify potential correlations between TBI severity and pituitary hormone deficiencies.
Main Methods:
- Retrospective study of 33 childhood TBI survivors.
- Hormone evaluation including basal levels, urine osmolality, and stimulation tests (GnRH, insulin tolerance, or glucagon).
- Assessment of growth, cortisol, and gonadotropin responses relative to age and pubertal stage.
Main Results:
- No short stature was observed; growth hormone responses were suboptimal in a few cases.
- Cortisol responses were adequate in most participants, with only a few showing suboptimal responses.
- No clinically significant endocrinopathy was identified, and abnormal findings were not linked to TBI severity or functional outcome.
Conclusions:
- Childhood TBI does not appear to cause clinically significant pituitary dysfunction.
- Minor pituitary hormone abnormalities may occur but do not necessitate routine endocrine replacement.
- Further research could explore specific hormone pathways affected by TBI in children.
Objectives:
Post-traumatic hypopituitarism is well described amongst adult traumatic brain injury (TBI) survivors. We aimed to determine the prevalence and clinical significance of pituitary dysfunction after head injury in childhood.
Design:
Retrospective exploratory study.
Patients:
33 survivors of accidental head injury (27 boys). Mean (range) age at study was 13·4 years (5·4-21·7 years) and median (range) interval since injury 4·3 years (1·4-7·8 years). Functional outcome at study: 15 good recovery, 16 moderate disability, two severe disability.
Measurements:
Early morning urine osmolality and basal hormone evaluation were followed by the gonadotrophin releasing hormone (GnRH) and insulin tolerance (n = 25) or glucagon tests (if previous seizures, n = 8). Subjects were not primed. Head injury details were extracted from patient records.
Results:
No subject had short stature (mean height SD score +0·50, range -1·57 to +3·00). Suboptimal GH responses (<5 μg/l) occurred in six peri-pubertal boys (one with slow growth on follow-up) and one postpubertal adolescent (peak GH 3·2 μg/l). Median peak cortisol responses to insulin tolerance or glucagon tests were 538 and 562 nm. Nine of twenty-five and two of eight subjects had suboptimal responses, respectively, two with high basal cortisol levels. None required routine glucocorticoid replacement. In three, steroid cover was recommended for moderate/severe illness or injury. One boy was prolactin deficient. Other basal endocrine results and GnRH-stimulated LH and FSH were appropriate for age, sex and pubertal stage. Abnormal endocrine findings were unrelated to the severity or other characteristics of TBI or functional outcome.
Conclusions:
No clinically significant endocrinopathy was identified amongst survivors of accidental childhood TBI, although minor pituitary hormone abnormalities were observed.
