Traumatic Brain Injury in Children and Adolescents: Surveillance for Pituitary Dysfunction

Norwood, Kenneth W.; DeBoer, Mark D.; Gurka, Matthew J.; Kuperminc, Michelle N.; Rogol, Alan D.; Blackman, James A.; Wamstad, Julia B.; Buck, Marcia L.; Patrick, Peter D.

doi:10.1177/0009922810376234

Cited by 43 publications

(39 citation statements)

References 32 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: 88%

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: 88%

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

Greco¹,

Hovda²,

Prins³

2013

Journal of Neurotrauma

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“…Broadly, hypothalamic-pituitary dysfunction was identified in nearly 70% of patients following TBI [13]. The most common manifestations of hypopituitarism are growth hormone (GH), gonadotrophin and thyroid-stimulating hormone (TSH) deficiencies [14,15]. Many pituitary hormones are involved in bone metabolism.…”

Section: Introductionmentioning

confidence: 99%

The negative impact of traumatic brain injury (TBI) on bone in a mouse model

Watt

Mohan

2013

Brain Injury

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“…In the endocrine system, TBI causes hypopituitarism, i.e., decreased secretion of pituitary hormones. Deficiency of the anterior pituitary hormone, GH, is one of the most common forms of hypopituitarism [14]. Since circulating GH stimulates the production and secretion of IGF-1 in the liver, GH functions are primarily mediated through IGF-1, and IGF-1 is an anabolic hormone that stimulates the growth of nearly every cell in the body, IGF-1 can be used as a systemic indicator of TBI impact [45].…”

Section: Discussionmentioning

confidence: 99%

“…Pituitary dysfunction is relatively common following TBI [11][12] and present in 25 to 70 percent of the patients following a moderate-to-severe TBI [10]. A common form of pituitary dysfunction is hypopituitarism, i.e., deficiencies of pituitary hormones such as growth hormone (GH), gonadotropins, thyroid-stimulating hormone, and adrenocorticotropic hormone [13][14]. Pituitary hormones such as GH and downstream players such as liver-produced insulin-like growth factor 1 (IGF-1) are important regulators of bone formation and contribute to peak bone mass [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Reduced bone mass accrual in mouse model of repetitive mild traumatic brain injury

Yu¹,

Wergedal²,

Rundle³

et al. 2014

J Rehabil Res Dev

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Abstract-Traumatic brain injury (TBI) can affect bone by influencing the production/actions of pituitary hormones and neuropeptides that play significant regulatory roles in bone metabolism. Previously, we demonstrated that experimental TBI exerted a negative effect on the skeleton. Since mild TBI (mTBI) accounts for the majority of TBI cases, this study was undertaken to evaluate TBI effects using a milder impact model in female mice. Repetitive mTBI caused microhemorrhaging, astrocytosis, and increased anti-inflammatory protective actions in the brain of the impacted versus control mice 2 wk after the first impact. Serum levels of growth regulating insulin-like growth factor 1 (IGF-1) were reduced by 28.9%. Bone mass was reduced significantly in total body as well as individual skeletons. Tibial total cortical density was reduced by 7.0%, which led to weaker bones, as shown by a 31.3% decrease in femoral size adjusted peak torque. A 27.5% decrease in tibial trabecular bone volume per total volume was accompanied by a 34.3% (p = 0.07) decrease in bone formation rate (BFR) per total area. Based on our data, we conclude that repetitive mTBI exerted significant negative effects on accrual of both cortical and trabecular bone mass in mice caused by a reduced BFR.

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Traumatic Brain Injury in Children and Adolescents: Surveillance for Pituitary Dysfunction

Cited by 43 publications

References 32 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

The negative impact of traumatic brain injury (TBI) on bone in a mouse model

Reduced bone mass accrual in mouse model of repetitive mild traumatic brain injury

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