Secondary adrenal insufficiency in the acute phase of pediatric traumatic brain injury

Dupuis, Clémentine; Thomas, Sébastien; Faure, Patrice; Gayot, A.; Desrumaux, Amélie; Wroblewski, I.; Debillon, Thierry; Émériaud, Guillaume

doi:10.1007/s00134-010-2012-4

Cited by 15 publications

(11 citation statements)

References 31 publications

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“…In children, most cases appear to be diagnosed by 6 months after injury, with the majority of cases resolving within 1 year. [59][60][61][62][63][64][65][66] In the current experiments, significant decreases in either GH or IGF-1 were not present in single injury animals. In the RTBI group, IGF-1 was significantly reduced at 1 week, and continued to be low at 1 month, whereas GH was only significantly decreased at 1 month after injury.…”

Section: Incidence and Time Course Of Hormonal Changesmentioning

confidence: 91%

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

Greco¹,

Hovda²,

Prins³

2013

Journal of Neurotrauma

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Adolescents are one of the highest groups at risk for sustaining both traumatic brain injury (TBI) and repeat TBI (RTBI). Consequences of endocrine dysfunction following TBI have been routinely explored in adults, but studies in adolescents are limited, and show an incidence rate of endocrine dysfunction in 16-61% in patients, 1-5 years after injury. Similar to in adults, the most commonly affected axis is growth hormone (GH) and insulin-like growth hormone 1 (IGF-1). Despite TBI being the primary cause of morbidity and mortality among the pediatric population, there are currently no experimental studies specifically addressing the occurrence of pituitary dysfunction in adolescents. The present study investigated whether a sham, single injury or four repeat injuries (24 h interval) delivered to adolescent rats resulted in disruption of the GH/IGF-1 axis. Circulating levels of basal GH and IGF-1 were measured at baseline, 24 h, 72 h, 1 week, and 1 month after injury, and vascular permeability of the pituitary gland was quantified via Evans Blue dye extravasation. Changes in weight and length of animals were measured as a potential consequence of GH and IGF-1 disruption. The results from the current study demonstrate that RTBI results in significant acute and chronic decreases in circulation of GH and IGF-1, reduction in weight gain and growth, and an increase in Evans Blue dye extravasation in the pituitary compared with sham and single injury animals. RTBI causes significant disruption of the GH/IGF-1 axis that may ultimately affect normal cognitive and physical development during adolescence.

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Section: Incidence and Time Course Of Hormonal Changesmentioning

confidence: 91%

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

Greco¹,

Hovda²,

Prins³

2013

Journal of Neurotrauma

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“…Although HPA axis alterations have been described in children suffering from meningococcal sepsis [10][11][12], the dynamics, drivers and prognostic value of systemic cortisol availability in the broader population of critically ill children have only scarcely been investigated [13,14]. Nevertheless, studies have suggested that a substantial proportion of critically ill children may not be able to increase systemic cortisol availability enough to face the stress of the critical illness, which could cause hemodynamic instability and systemic hyperinflammation with need for vasopressor support [15,16]. As a consequence, pediatric intensivists often prescribe systemic corticosteroids, often in quite high doses, although adequately powered RCTs investigating its clinical efficacy and safety in children are lacking [15,16].…”

Section: Introductionmentioning

confidence: 99%

Dynamics and prognostic value of the hypothalamus–pituitary–adrenal axis responses to pediatric critical illness and association with corticosteroid treatment: a prospective observational study

et al. 2019

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Purpose: Increased systemic cortisol availability during adult critical illness is determined by reduced binding-proteins and suppressed breakdown rather than elevated ACTH. Dynamics, drivers and prognostic value of hypercortisolism during pediatric critical illness remain scarcely investigated. Methods: This preplanned secondary analysis of the PEPaNIC-RCT (N = 1440), after excluding 420 children treated with corticosteroids before PICU-admission, documented (a) plasma ACTH, (free)cortisol and cortisol-metabolism at PICU-admission, day-3 and last PICU-day, their prognostic value, and impact of withholding early parenteral nutrition (PN), (b) the association between corticosteroid-treatment and these hormones, and (c) the association between corticosteroid-treatment and outcome. Results: ACTH was normal upon PICU-admission and low thereafter (p ≤ 0.0004). Total and free cortisol were only elevated upon PICU-admission (p ≤ 0.0003) and thereafter became normal despite low binding-proteins (p < 0.0001) and persistently suppressed cortisol-metabolism (p ≤ 0.03). Withholding early-PN did not affect this phenotype. On PICU-day-3, high free cortisol and low ACTH independently predicted worse outcome (p ≤ 0.003). Also, corticosteroidtreatment initiated in PICU, which further suppressed ACTH (p < 0.0001), was independently associated with poor outcomes (earlier live PICU-discharge: p < 0.0001, 90-day mortality: p = 0.02). Conclusion: In critically ill children, systemic cortisol availability is elevated only transiently, much lower than in adults, and not driven by elevated ACTH. Further ACTH lowering by corticosteroid-treatment indicates active feedback inhibition at pituitary level. Beyond PICU-admission-day, low ACTH and high cortisol, and corticosteroid-treatment, predicted poor outcome. This suggests that exogenously increasing cortisol availability during acute critical

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“…Similarly, Dupuis et al 5 reported that 36% of pediatric patients with TBI have secondary AI. Since it can be life-threatening, AI in the acute phase of TBI has received special attention 6 7.…”

Section: Introductionmentioning

confidence: 92%

Assessment of the Effect of Continuous Sedation with Mechanical Ventilation on Adrenal Insufficiency in Patients with Traumatic Brain Injury

Zhang

et al. 2016

Journal of Investigative Medicine

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The aim of this study was to assess the effect of continuous propofol sedation plus prolonged mechanical ventilation on adrenal insufficiency (AI) in patients with traumatic brain injury (TBI). Eighty-five adult patients diagnosed with moderate TBI (Glasgow Coma Scale (GCS) score 9-13) from October 2011 to October 2012 were included in this prospective study. The patients comprised three groups: no mechanical ventilation and sedation (n=27), mechanical ventilation alone (n=24) and mechanical ventilation plus sedation (n=34). The low-dose short Synacthen test was performed at 8:00 on the first, third, and fifth days after TBI. Logistic regression analysis was performed to identify factors affecting the use of mechanical ventilation and sedation, and the incidence of AI. On the fifth day after injury, the mean baseline cortisol and simulated cortisol levels were significantly lower in the mechanical ventilation plus sedation group compared with the other two groups. Multivariate regression analysis showed that the Acute Physiology and Chronic Health Evaluation (APACHE) score was independently associated with treatment with mechanical ventilation and sedation compared to mechanical ventilation alone. Furthermore, hypoxemia on admission and shock were associated with the development of AI. The findings showed that sedation is associated with an increased incidence of AI. Patients with TBI who are treated with continuous sedation should be monitored for AI carefully.

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Secondary adrenal insufficiency in the acute phase of pediatric traumatic brain injury

Cited by 15 publications

References 31 publications

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

The Effects of Repeat Traumatic Brain Injury on the Pituitary in Adolescent Rats

Dynamics and prognostic value of the hypothalamus–pituitary–adrenal axis responses to pediatric critical illness and association with corticosteroid treatment: a prospective observational study

Assessment of the Effect of Continuous Sedation with Mechanical Ventilation on Adrenal Insufficiency in Patients with Traumatic Brain Injury

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