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Is routine endocrine evaluation necessary after paediatric traumatic brain injury?
M A Salomón-Estébanez1, G Grau, A Vela
1Department of Paediatric Endocrinology, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Biscay, Spain.
Insights
This study found no pituitary dysfunction in children after traumatic brain injury (TBI). Routine endocrine evaluation may not be necessary for pediatric TBI survivors, even with moderate to severe injuries.
Area of Science:
- Pediatric Endocrinology
- Neurotrauma
- Child Neurology
Background:
- Traumatic brain injury (TBI) is common in children and can cause hypopituitarism.
- Endocrine evaluation is suggested for adult TBI survivors, but data in children are inconsistent.
Purpose of the Study:
- To determine the prevalence of pituitary dysfunction following TBI in a pediatric cohort.
- To assess the need for routine endocrine screening in children with TBI.
Main Methods:
- Cross-sectional study combining retrospective and prospective data.
- Recruited children discharged from Pediatric Intensive Care Unit (PICU) after TBI (2004-2009).
- Included height, weight, systemic examination, baseline pituitary function tests, and provocative tests if needed.
Main Results:
- Thirty-six pediatric TBI patients assessed (mean age 7.2 years, mean follow-up 3.3 years).
- All had skull fracture or intracranial hemorrhage; 36.6% had moderate to severe TBI.
- No abnormalities found on examination; some had low IGF-1 or cortisol, but no confirmed pituitary dysfunction.
Conclusions:
- No endocrine sequelae were detected in this pediatric TBI cohort.
- Routine endocrine evaluation may not be justified for children with mild to moderate TBI based on these findings.
Background:
Traumatic brain injury (TBI) is a common event in childhood. It is a recognised cause of hypopituitarism both in adult and paediatric patients. Routine endocrine evaluation has been proposed for adult TBI-survivors; nevertheless, incongruous data have been reported in children.
Aim:
The goal of this study was to describe the prevalence of pituitary dysfunction after TBI in a cohort of children.
Material/Subjects And Methods:
This is a cross-sectional study comprising retrospective medical record review and prospective testing. Children with brain injury discharged from the Paediatric Intensive Care Unit from year 2004 to 2009 were recruited. Height and weight were recorded, systemic examination was performed and baseline pituitary function tests were undertaken. Provocative tests were performed only if abnormal basal levels were detected.
Results:
Thirty-six patients were collected; the mean age at assessment was 7.2 years and the mean interval since injury 3.3 years. All patients had skull fracture or intracranial haemorrhage; 36.6 % of them had moderate to severe TBI. No abnormalities were found on examination. Low serum IGF 1 levels were detected in four patients and two patients had low serum cortisol levels with inappropriately normal plasma ACTH concentrations. No evidence of pituitary dysfunction was observed in these patients after clinical follow-up, repeated baseline hormone levels or dynamic function tests.
Conclusions:
No endocrine sequelae have been detected in this population. The routine endocrine evaluation in children with mild to moderate TBI might not be justified, according to our findings.
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