Hypothalamo-hypophysial Dysfunction After Traumatic Brain Injury in Children and Adolescents: A Preliminary Retrospective and Prospective Study

Abstract

With two study protocols, one retrospective and the other prospective, we evaluated hypothalamo-hypophysial dysfunction (HHD) in paediatric patients treated for traumatic brain injury (TBI) in the neurosurgical or intensive care department at our hospital. The retrospective group comprised 22 patients who had experienced TBI 0.7-7.25 years before the study. The prospective group included 30 patients assessed at TBI (T0), 26 of 30 after 6 months (T6), and 20 of 26 after 12 months (T12). Auxological and hormonal basal parameters of hypothalamo-hypophysial function were evaluated at recall in the retrospective group, and at T0, T6 and T12 in the prospective group. Basal data and standard dynamic tests in selected patients revealed one with precocious puberty, one with total anterior hypopituitarism, one with central hypogonadism, and one with growth hormone (GH) deficiency in the retrospective group; three patients with cerebral salt-wasting syndrome, one with diabetes insipidus and seven with low T3 syndrome at T0 (all transient), one with hypocorticism at T6 confirmed at T12, and one with GH deficiency at T12 in the prospective group. The results of our study show that post-TBI HHD in our paediatric cohort is not uncommon. Of the 48 patients who underwent a complete evaluation (22 retrospective study patients and 26 prospective study patients evaluated at T6) five (10.4%) developed HHD 6 months or more after TBI. HHD was newly diagnosed in one previously normal patient from the prospective group at 12 months after TBI. GH deficiency was the most frequent disorder in our paediatric cohort.

Hypopituitarism in childhood and adolescence following traumatic brain injury: the case for prospective endocrine investigation

“…Pituitary deficiency has been reported after severe brain trauma, often associated not only with loss of consciousness, subdural haematoma or skull fracture (26)(27)(28)(29), but also following relatively mild head injury without loss of consciousness (30)(31)(32). A recent preliminary retrospective and prospective analysis of paediatric and adolescent patients also confirmed the risk of pituitary dysfunction (33).…”

Hypothalamopituitary Dysfunction Following Traumatic Brain Injury and Aneurysmal Subarachnoid Hemorrhage

“…Pituitary hormone secretion is regulated by hypothalamic-releasing hormones and inhibitory factors (which are released into the portal circulation in the pituitary 10,11,13,26 to avoid the confounding effect of acute critical illness on neuroendocrine function and studies on pediatric populations for reasons of homogeneity 24,25 ). Of these, the pooled prevalences of anterior hypopituitarism after TBI and aneurysmal SAH were 27.5% (95% CI, 22.8%-28.9%) and 47% (95% CI 37.4%-56.8%), respectively.…”

Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

“…[4][5][6][7][8] Previous prospective studies have often found resolution of some endocrine abnormalities by 1 year after TBI. For this reason, we elected to only study children who were at least 1 year after injury.…”

“…However, few studies have systematically evaluated the prevalence of endocrine dysfunction in children after TBI. [4][5][6][7][8] Among studies in children, there is a 16-61% prevalence of hypopituitarism at 1-5 years after injury. [4][5][6][7][8] Two studies with prospective data in the pediatric age range have shown an incidence of 10 4 and 29% 8 pituitary deficiency at 1 year after injury.…”