Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

Abstract

Endocrine dysfunction is common after accidental traumatic brain injury (TBI). Prevalence of endocrine dysfunction after inflicted traumatic brain injury (iTBI) is not known. The aim of this study was to examine endocrinopathy in children after moderate-to-severe iTBI. Children with previous iTBI (n = 14) were evaluated for growth/endocrine dysfunction, including anthropometric measurements and hormonal evaluation (nocturnal growth hormone [GH], thyrotropin surge, morning and low-dose adrenocorticotropin stimulated cortisol, insulin-like growth factor 1, IGF-binding protein 3, free thyroxine, prolactin [PRL], and serum/urine osmolality). Analysis used Fisher's exact test and Wilcoxon's rank-sum test, as appropriate. Eighty-six percent of subjects had endocrine dysfunction with at least one abnormality, whereas 50% had two or more abnormalities, significantly increased compared to an estimated 2.5% with endocrine abnormality in the general population ( p < 0.001). Elevated prolactin was common (64%), followed by abnormal thyroid function (33%), short stature (29%), and low GH peak (17%). High prolactin was common in subjects with other endocrine abnormalities. Two were treated with thyroid hormone and 2 may require GH therapy. In conclusion, children with a history of iTBI show high risk for endocrine dysfunction, including elevated PRL and growth abnormalities. This effect of iTBI has not been well described in the literature. Larger, multi-center, prospective studies would provide more data to determine the extent of endocrine dysfunction in iTBI. We recommend that any child with a history of iTBI be followed closely for growth velocity and pubertal changes. If growth velocity is slow, PRL level and a full endocrine evaluation should be performed.

The Prevalence of Pituitary Dysfunction in Children Following Severe Traumatic Brain Injury in the Acute Phase

“…In several studies with larger numbers, dysfunction of at least one pituitary axis is reported in a large number of patients (50 to 83%) [11,12,13].…”

Post‐traumatic hypopituitarism: report of a child case

“…There is no definite recommendation that routine endocrine evaluation should be carried out following TBI. 13,14 Auble et al recommended that any child with a history of TBI be followed closely for growth velocity and pubertal changes. If growth velocity is slow, prolactin level and a full endocrine evaluation should be undertaken.…”

Increasing severity of traumatic brain injury in early childhood is associated with a progressive reduction in long‐term serum thyroid‐stimulating hormone concentrations

“…Increasing severity of traumatic brain injury in early childhood is associated with a progressive reduction in long-term serum thyroid-stimulating hormone concentrations Structural traumatic brain injury (TBI) can result in late-occurring health sequelae, consisting mainly of neuroendocrine dysfunctions. 1,2 Studies have suggested that hypopituitarism is relatively common following TBI in childhood, but recent evidence suggests that the incidence appears to be frequently overestimated. 3 We recently showed that permanent hypopituitarism is rare after both inflicted and accidental structural TBI in early childhood.…”

“…4 A recent small pilot study reported a subtle reduction in overnight thyroid-stimulating hormone (TSH) surge in children following moderate-to-severe inflicted TBI. 1 Thus, it is unclear whether injury severity can be responsible for more subtle long-term effects on thyroid function in the absence of hypopituitarism. Therefore, we assessed whether severity of TBI was associated with changes in circulating thyroid hormone concentrations in childhood in a cross-sectional study.…”

“…Conversely, in a cohort of 14 children with moderate-tosevere inflicted TBI, 12 children (86%) showed at least one endocrine or growth alteration, with abnormal thyroid function in 33% of them. 1 The specific mechanisms leading to long-term changes in thyroid function following TBI are unclear. Autopsy results suggest that vascular injury is common.…”