Prevalence of Pituitary Dysfunction After Severe Traumatic Brain Injury in Children and Adolescents: A Large Prospective Study

Abstract

At 1 year after the severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after a severe TBI and prolonged clinical endocrine follow-up.

Pituitary dysfunction after traumatic brain injury: are there definitive data in children?

“…Poomthavorn et al 22 evaluated patients a long time after TBI and included 20 pubertal patients who had not experienced delayed or arrested puberty following TBI. Precocious puberty was described by Kaulfers et al 24 in three patients, but most of the cohorts included one case of precocious puberty in each studied group 20 22 29. Khadr et al 26 and Casano-Sancho et al 28 did not report a single case of precocious puberty.…”

“…Other retrospective studies, such as the one published by Eunadi,20 restricted the dynamic tests to patients with low growth velocity; Norwood et al 25 and Khadr et al 26 carried out cross-sectional studies, showing a wide range of hypopituitarism from 48% to 25%. Prospective studies such as those by Kaulfers et al ,24 Niederland et al ,21 Casano-Sancho et al 28 and Personnier et al 29 used functional hormonal testing irrespective of clinical symptoms and found a high prevalence of pituitary dysfunction.…”

“…Surprisingly, a lower prevalence of hypogonadism has been described in the paediatric series. One of the largest cohorts was described by Personnier et al ,29 including 85 patients; it considered gonadal function of 23 pubertal or postpubertal patients. The authors reported no evidence of delayed puberty or secondary amenorrhoea.…”

“…Personnier et al 29 reported seven patients with elevated baseline prolactin levels; they performed a second measure 15 min later and observed normalisation or a decrease in five patients. The higher levels in the other two patients were attributed to stress and no further studies were performed.…”

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: A Neuroendocrine Approach to Patients With Traumatic Brain Injury

“…A study of 23 patients in the transition period (ages 16 to 25 years) found that hypopituitarism was present in 34.6% at 3 months after TBI, and at 12 months, hypopituitarism was present in 30.3% (13). On the other hand, the prevalence of hypopituitarism was only 8% in a study of 87 children and adolescents who were evaluated at 12 months after severe TBI (14), whereas in another study of 198 children with remote history of TBI in early childhood, low peak stimulated GH and cortisol levels were found in only 8% of the subjects (15).…”