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Pituitary function at long-term follow-up of childhood traumatic brain injury
Rebecca Jane Moon1, Timothy Sutton, Peter Murray Wilson
1Paediatric Endocrinology, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, United Kingdom.
Insights
Traumatic brain injury (TBI) in children rarely leads to pituitary dysfunction long-term. This study found low prevalence, suggesting routine endocrine screening is not necessary after pediatric TBI.
Area of Science:
- Pediatric Endocrinology
- Neurotrauma
- Child Neurology
Background:
- Pituitary dysfunction is a known complication of traumatic brain injury (TBI) in adults, but data in children are limited.
- Understanding the long-term endocrine sequelae of pediatric TBI is crucial for appropriate patient management.
Purpose of the Study:
- To assess pituitary function in children and young adults at least 4 years post-TBI.
- To evaluate the impact of TBI and potential hypopituitarism on growth, adiposity, and quality of life (QOL).
Main Methods:
- Recruited patients under 18 years old admitted to a pediatric intensive care unit (PICU) for TBI.
- Collected blood and urine samples for pituitary function tests; measured height, weight, and adiposity.
- Assessed QOL using validated questionnaires and compared auxology/adiposity to healthy controls.
Main Results:
- Only one of 20 participants showed biochemical evidence of hypopituitarism.
- Height, weight, and adiposity were comparable to age- and sex-matched healthy controls.
- Poor QOL was associated with chronic functional deficits or comorbidities, not pituitary dysfunction.
Conclusions:
- Pituitary dysfunction is less common in children after TBI than previously reported in adults.
- Routine endocrine evaluation is not supported by these findings in children following TBI.
- Focus on functional deficits and comorbidities may be more beneficial for QOL in pediatric TBI survivors.
Abstract:
Pituitary dysfunction is a recognized sequela of traumatic brain injury (TBI), occurring in 10-83% of adult patients, but there are few data on the prevalence or natural history in childhood. Our objective was to determine pituitary function in children and young adults at least 4 years after TBI requiring pediatric intensive care unit (PICU) admission. The effects of TBI and hypopituitarism on height, adiposity, and quality of life (QOL) were also evaluated. Unselected patients discharged from the regional PICU with TBI (age < 18 years at injury) from 1999-2004 were recruited. Blood and urine samples were collected for baseline pituitary function testing. Height and weight were measured. Adiposity was assessed by mid-upper arm and waist circumferences, and body fat percentage estimation using four-site skinfold thickness and bioelectrical impedance. Auxology and adiposity data were compared to local age- and sex-matched healthy control data. QOL questionnaires (PedsQL 4.0 and QOL-AGHDA) were completed. Twenty subjects (median age 16.7 years, range 9.2-23.3 years, 13 male) of 127 who were eligible agreed to participate at a median of 6.8 years (range 4.2-10.3 years) since TBI. Markers of injury were higher in those recruited than those who were not. Biochemical evidence of hypopituitarism was identified in only one case, possibly related to comorbid pre-existing attention deficit-hyperactivity disorder. Height, weight, and adiposity were similar to healthy controls. Poor QOL was seen in patients with chronic functional deficits or comorbidities. Overall, pituitary dysfunction was less prevalent than in previous studies in adults and children. The results of this study do not support the use of routine endocrine evaluation of children following TBI.
