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Hypopituitarism in pediatric survivors of inflicted traumatic brain injury
Bethany A Auble1, Sureka Bollepalli, Kathi Makoroff
11 Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine , Cincinnati, Ohio.
Insights
Inflicted traumatic brain injury (iTBI) in children frequently causes endocrine dysfunction, with 86% experiencing abnormalities. Elevated prolactin and growth issues are common, highlighting the need for careful monitoring after iTBI.
Area of Science:
- Pediatric Endocrinology
- Pediatric Neurology
- Child Abuse Research
Background:
- Endocrine dysfunction is a known complication of accidental traumatic brain injury (TBI).
- The prevalence and spectrum of endocrine dysfunction following inflicted traumatic brain injury (iTBI) in children remain largely uncharacterized.
- iTBI represents a significant cause of pediatric brain injury, necessitating investigation into its long-term sequelae.
Purpose of the Study:
- To investigate the prevalence and types of endocrine dysfunction in children who have sustained moderate-to-severe iTBI.
- To characterize hormonal abnormalities, including growth hormone, thyroid, adrenal, and prolactin axes, in this vulnerable population.
- To establish the clinical significance of endocrine sequelae following iTBI.
Main Methods:
- Retrospective evaluation of 14 children with a history of iTBI.
- Comprehensive assessment including anthropometric measurements and detailed hormonal evaluations (GH, IGF-1, IGFBP-3, TSH, free T4, cortisol, PRL, osmolality).
- Statistical analysis using Fisher's exact test and Wilcoxon's rank-sum test to compare findings with general population data.
Main Results:
- A high prevalence of endocrine dysfunction was observed, with 86% of subjects exhibiting at least one abnormality and 50% showing two or more.
- Common endocrine abnormalities included elevated prolactin (64%), abnormal thyroid function (33%), short stature (29%), and low growth hormone (GH) peak (17%).
- Elevated prolactin levels were frequently associated with other endocrine dysfunctions. Two children required thyroid hormone treatment, and two may need GH therapy.
Conclusions:
- Children with a history of iTBI are at a significantly elevated risk for developing endocrine dysfunction, including hyperprolactinemia and growth abnormalities.
- The findings underscore a critical, under-recognized complication of iTBI in pediatric populations.
- Close monitoring of growth velocity and pubertal development, coupled with endocrine evaluation for children with iTBI, is strongly recommended.
Abstract:
Endocrine dysfunction is common after accidental traumatic brain injury (TBI). Prevalence of endocrine dysfunction after inflicted traumatic brain injury (iTBI) is not known. The aim of this study was to examine endocrinopathy in children after moderate-to-severe iTBI. Children with previous iTBI (n=14) were evaluated for growth/endocrine dysfunction, including anthropometric measurements and hormonal evaluation (nocturnal growth hormone [GH], thyrotropin surge, morning and low-dose adrenocorticotropin stimulated cortisol, insulin-like growth factor 1, IGF-binding protein 3, free thyroxine, prolactin [PRL], and serum/urine osmolality). Analysis used Fisher's exact test and Wilcoxon's rank-sum test, as appropriate. Eighty-six percent of subjects had endocrine dysfunction with at least one abnormality, whereas 50% had two or more abnormalities, significantly increased compared to an estimated 2.5% with endocrine abnormality in the general population (p<0.001). Elevated prolactin was common (64%), followed by abnormal thyroid function (33%), short stature (29%), and low GH peak (17%). High prolactin was common in subjects with other endocrine abnormalities. Two were treated with thyroid hormone and 2 may require GH therapy. In conclusion, children with a history of iTBI show high risk for endocrine dysfunction, including elevated PRL and growth abnormalities. This effect of iTBI has not been well described in the literature. Larger, multi-center, prospective studies would provide more data to determine the extent of endocrine dysfunction in iTBI. We recommend that any child with a history of iTBI be followed closely for growth velocity and pubertal changes. If growth velocity is slow, PRL level and a full endocrine evaluation should be performed.
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