Permanent Hypopituitarism Is Rare after Structural Traumatic Brain Injury in Early Childhood

Heather, Natasha; Jefferies, Craig; Hofman, Paul L.; Derraik, José G. B.; Brennan, Christine; Kelly, Patrick J.; Hamill, James; Jones, Rhys; Rowe, Deborah; Cutfield, Wayne S.

doi:10.1210/jc.2011-2284

Cited by 60 publications

(56 citation statements)

References 34 publications

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“…Heather and colleagues described a large number of 64 pediatric patients with inflicted injuries as part of a cross-sectional series of 198 patients and found no cases of permanent hypopituitarism at least 1 year after injury. 3 However, our study is different from the previous work in several important ways. Of course, we report far fewer patients than they did.…”

Section: Discussioncontrasting

confidence: 66%

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Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

Auble¹,

Makoroff²,

Weis³

et al. 2011

CLINICAL/TRANSLATIONAL - Pediatric Endocrinology: Turner Syndrome, Growth, Pituitary, Congenital Adrenal Hyperplasia &Amp; Adre

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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.

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Section: Discussioncontrasting

confidence: 66%

“…However, prevalence of endocrine dysfunction after iTBI has been described in only one previous study. 3 Many case reports have documented pituitary dysfunction after TBI in individual children. However, few studies have systematically evaluated the prevalence of endocrine dysfunction in children after TBI.…”

Section: Introductionmentioning

confidence: 99%

Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

Auble¹,

Makoroff²,

Weis³

et al. 2011

CLINICAL/TRANSLATIONAL - Pediatric Endocrinology: Turner Syndrome, Growth, Pituitary, Congenital Adrenal Hyperplasia &Amp; Adre

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“…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).…”

Section: Epidemiologymentioning

confidence: 93%

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

2015

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“…However, recent data from large cohorts raised doubt about the evidence behind such recommendations, as they were unable to confirm the previously reported high prevalence of pituitary dysfunction (2,3,4). Although severe hypopituitarism may certainly present as a complication to brain injury, mostly mild and often irreproducible deficiencies have been reported.…”

Section: Introductionmentioning

confidence: 92%

Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism

Klose

Stochholm

Janukonyté

et al. 2015

European Journal of Endocrinology

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Objective: Posttraumatic pituitary hormone deficiency is often suggested. The impact of these predominantly mild and often irreproducible deficiencies on outcome is less clear. The aim of the present study was to describe patient reported outcome in a national a priori unselected cohort of patients with traumatic brain injury (TBI) in relation to deficiencies identified upon pituitary assessment. Design and methods: We conducted a nationwide population-based cohort study. Participants were Danish patients with a head trauma diagnosis recorded in the Danish Board of Health diagnostic code registry; 439 patients (and 124 healthy controls) underwent assessment of anterior pituitary function 2.5 years (median) after TBI. Questionnaires on health-related quality of life (QoL) (SF36, EuroQoL-5D, QoL assessment of GH deficiency in adults) and fatigue were completed in parallel to pituitary assessment. Results: Patients with TBI had significant detriments in QoL. Impairment (mainly physical scales) related to pituitary deficiency, although only partially confirmed after adjustment for demographic differences. Hypogonadotropic hypogonadism related to several QoL scores. Increasing impairments were observed with declining total testosterone concentrations (men), but not free testosterone concentrations or any other hormone concentrations. Total testosterone was not independently related to impaired QoL and fatigue, after adjustment for demographics, and treatment with antidiabetics, opioids, antidepressants, and anticonvulsants. Conclusions: Only a very limited relationship between pituitary hormone deficiencies and QoL/fatigue was demonstrated. Due to the dominating influence of concurrent comorbidities, pituitary deficiencies were not independently related to QoL/fatigue. Causality is still to be shown, and whether substitution therapy could be of additional relevance in selected patients needs to be proven.

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Permanent Hypopituitarism Is Rare after Structural Traumatic Brain Injury in Early Childhood

Abstract: Permanent hypopituitarism is rare after both inflicted and accidental structural TBI in early childhood. Precocious puberty was the only pituitary hormone abnormality found, but the prevalence did not exceed that of the normal population.

Cited by 60 publications

References 34 publications

Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

Hypopituitarism in Pediatric Survivors of Inflicted Traumatic Brain Injury

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

Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism

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