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Published on: November 19, 2012
Endocrine Abnormalities in Children With Traumatic Brain Injury at a Tertiary Care Center
Aaida Rao1, Altaf Ali Laghari1, Iman Bari2
1Neurosurgery, Aga Khan University Hospital, Karachi, PAK.
Insights
Traumatic brain injury (TBI) in children can cause endocrine abnormalities, impacting long-term health. This study found high IGF-1, testosterone, and free T4 levels linked to better outcomes in pediatric TBI patients.
Area of Science:
- Pediatric Endocrinology
- Neuroscience
- Public Health in LMICs
Background:
- Traumatic brain injury (TBI) in children can lead to significant endocrine abnormalities and long-term morbidities.
- These complications pose a substantial treatment cost burden, particularly in low-to-middle-income countries (LMICs).
- The prevalence of TBI-induced endocrine issues in Pakistani children remains understudied.
Purpose of the Study:
- To estimate the burden of endocrine abnormalities secondary to TBI among children in Pakistan.
- To explore correlations between hormonal levels, demographic factors, interventions, and complication rates in pediatric TBI patients.
Main Methods:
- Retrospective cross-sectional study of 20 pediatric patients admitted with head injury.
- Analysis of baseline serum hormones including IGF-1, testosterone, fT4, and others.
- Data collation from electronic Health and Information Management System (HIMS) and statistical analysis using SPSS v25.
Main Results:
- Three patients (15%) exhibited pituitary hormone deficits; three (15%) had high IGF-1 and ACTH.
- High IGF-1 correlated with female gender, mechanical ventilation, and falls.
- Elevated IGF-1, GH, testosterone, and fT4 levels were associated with improved functional outcomes (GOS-E scores).
- Neurosurgical decompression was a risk factor for hormone deficiency; learning difficulties were exclusive to children with hormonal deficits.
Conclusions:
- Hormonal dysfunction following pediatric TBI is linked to adverse outcomes.
- Higher levels of IGF-1, testosterone, and free T4 may indicate improved functional recovery.
- Limited resources and follow-up in LMICs hinder management of TBI-related endocrine morbidity, necessitating health policy interventions.
Abstract:
Objective Accidental traumatic brain injury (TBI) can lead to severe complications such as endocrine abnormalities and long-term morbidities and can negatively impact patient lives. These conditions are also associated with a high cost of treatment over a lifetime, a significant concern in low-to-middle-income countries (LMICs). In Pakistan, the prevalence of children with endocrine abnormalities secondary to TBI remains largely unexplored. We conducted a retrospective cross-sectional study to estimate the burden of endocrine abnormalities due to TBI among children in our population. Methods Twenty patients previously admitted with head injury between September and October 2019 were retrospectively reviewed with tests for baseline serum sodium, plasma osmolality, cortisol, adrenocorticotropin (ACTH), free thyroxine (fT4), growth hormone (GH), insulin growth factor-1 (IGF-1), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin, estradiol, and testosterone. Data were collated from the electronic Health and Information Management System (HIMS) and analyzed using SPSS v25. Chi-square and t-tests were used to identify associations between variable groups. Outcomes of interest included correlations between hormonal levels and demographic factors, interventions and hormonal levels, and complication rates and hormonal levels. Results Our study reports three (15% of the total cohort) patients with pituitary hormone deficits (two with low IGF-1 and one with low TSH). High serum IGF-1 and ACTH levels were also observed in three (15%) children. High IGF-1 was associated with female gender (p=0.007), mechanical ventilation (p=0.038), and falls (p=0.028). IGF-1 (p=0.035) and GH (p=0.049) levels were associated with improvement in Extended Glasgow Outcome Scale (GOS-E) score. Testosterone was positively correlated with a high percentile for height (p=0.005) and GOS-E scores on follow-up (p=0.030). High testosterone levels (592.12 ± 102.28 ng/dl) were associated with good functional outcomes in post-pubescent patients (p<0.05). Serum fT4 was linked with a high GOS-E score at discharge in prepubescent patients (p=0.034). Neurosurgical decompression was the only risk factor for hormone deficiency, comprising 67% of the group with hormone deficiencies (p=0.028). The learning difficulties were observed exclusively in children with hormonal deficiencies (7 patients, p=0.000). Conclusion Hormonal dysfunction due to TBI in children can lead to poor outcomes. High serum IGF-1, testosterone, and free T4 levels were associated with improved functional outcomes in children with TBI. Limited follow-up and resources in LMICs are significant barriers to addressing the morbidity associated with these conditions and need to be addressed at a health policy level.
