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Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment?
Paula Casano-Sancho1, Larisa Suárez, Lourdes Ibáñez
1Pediatric Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Endocrinology, Hospital Sant Joan de Déu and CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
Insights
Children experiencing traumatic brain injury (TBI) may develop pituitary dysfunction, particularly affecting growth hormone (GH) levels. Long-term monitoring is recommended to manage potential consequences in pediatric patients post-TBI.
Area of Science:
- Pediatric Endocrinology
- Neurotrauma
- Hormone Research
Background:
- Hypopituitarism is documented in adults post-traumatic brain injury (TBI), but data in pediatric populations are limited.
- This study addresses the scarcity of information on pituitary function in children and young adults following TBI.
Purpose of the Study:
- To prospectively investigate the incidence and persistence of pituitary dysfunction in children and adolescents after TBI.
- To assess the impact of TBI on growth hormone (GH) and cortisol secretion.
- To determine if pituitary impairment can be predicted by injury severity.
Main Methods:
- A prospective, 1-year follow-up study of 37 children (aged 2 months to 19.9 years) post-TBI.
- Clinical and endocrine assessments at 3 and 12 months post-injury.
- Glucagon stimulation and megatest performed in children aged 6 years and older.
Main Results:
- Nearly half of patients (47.8%) aged ≥6 years showed subnormal GH peak at 3 months, with 34% persisting at 1 year.
- No correlation found between GH response and TBI severity (GCS, Marshall classification).
- Increased BMI SDS observed in children with low GH response; cortisol abnormalities normalized in most by 1 year. No abnormalities in children <6 years.
Conclusions:
- Pituitary function impairment after TBI in children is unpredictable and warrants prospective monitoring.
- Early identification and management of pituitary dysfunction are crucial to prevent long-term consequences.
- Further clinical trials are needed to establish systematic screening and potential GH therapy protocols.
Background:
Hypopituitarism has been widely described in adults after traumatic brain injury (TBI); however, the available data in paediatric populations are scarce. Here, we report the results of a prospective, long-term study in children, adolescents and young adults.
Study Group:
Thirty-seven children (age, 2 months to 19·9 years) of 51 eligible patients were followed for 1 year. Clinical and baseline endocrine variables were assessed in all 3 and 12 months after TBI; children ≥ 6 years underwent two stimulation tests (glucagon stimulation and megatest).
Results:
In the group ≥6 years, 11 of 23 patients (47·8%) had a subnormal GH peak 3 months after TBI that persisted in 8 of 23 patients (34%) after 1 year. The GH response showed no correlation with injury severity (GCS, Marshall classification). Growth velocity was normal in all patients, except for one. Body mass index (BMI) SDS increased significantly in the group with low GH response. A suboptimal cortisol was observed in 10 of 23 subjects, which normalized in all but three, 1 year thereafter. All patients but one showed a pubertal response to GnRH testing. No clinical or hormonal abnormalities were detectable in children <6 years.
Conclusion:
Our results recommend to prospectively follow children after TBI: firstly, because the impairment of pituitary function cannot be predicted, and secondly, to avoid the potential consequences of pituitary dysfunction. Prospective clinical trials are needed before recommending a systematic screening after TBI and/or GH therapy either in postpubertal children or in prepubertal children who grow normally.
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