Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

Abstract

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3–4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<−1 DS) or low IGF-1 (<−2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5–10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4–6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

Lipid Complications after Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

“…TBI in childhood can lead to permanent pituitary dysfunction. Growth hormone deficiency, puberty disorders, and central hypothyroidism may appear after many years [6]. High-dose chemotherapy-based regimens consist of many agents, but alkylating chemotherapeutics remain the mainstay of such regimens.…”

Diagnosis, genetics, and therapy of short stature in children: A growth hormone research society international perspective

“…Furthermore, there are rare patients who appear to have true GHD even though their stimulated GH peak exceeds traditional cutoffs. The combination of other clinical data (e.g., significant short stature, poor height velocity, delayed bone age, very low IGF-I, and abnormal head MRI) can indicate GHD irrespective of the GH level, and these patients may require GH therapy for adequate growth [48]. Such patients may warrant initiation of rhGH therapy with annual reassessment based upon growth response.…”

Long-term endocrine consequences of traumatic brain injury in children

“…Radiation therapy in children for brain tumors or leukemia may be considered another form of traumatic brain injury. The longer term responses to it may inform about anterior pituitary hormone deficiencies, and in young children, precocious puberty, as is a focus of the highlighted article (6). The effects of the treatment are localized, the dose quantitated and the timing and dose distribution (fractionation) known.…”

“…However, most of the hypothalamic/pituitary deficits noted in those receiving radiation therapy evolve slowly (over years) and are likely permanent. Those characteristics make the study design of Crosnier and coworkers, so important for their study encompassed 5 or more years in most of their patients (6). For children an example is the presence of growth failure and short stature due to GH deficiency.…”