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Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment?

Authors

  • Paula Casano-Sancho,

    Corresponding author
    1. Pediatric Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
    2. Endocrinology, Hospital Sant Joan de Déu and CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
    • Correspondence: Paula Casano-Sancho, Pediatric Endocrinology Unit, Sant Joan de Déu Hospital, Passeig Sant Joan de Déu, Barcelona, Spain. Tel.: +34-93-2804000 ext.71262; Fax: 34-93-2033959; E-mail: pcasano@hsjdbcn.org

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  • Larisa Suárez,

    1. Pediatric Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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  • Lourdes Ibáñez,

    1. Pediatric Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
    2. Endocrinology, Hospital Sant Joan de Déu and CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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  • Gemma García-Fructuoso,

    1. Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
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  • Julita Medina,

    1. Rehabilitation, Hospital Sant Joan de Déu, Barcelona, Spain
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  • Anna Febrer

    1. Rehabilitation, Hospital Sant Joan de Déu, Barcelona, Spain
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Summary

Background

Hypopituitarism has been widely described in adults after traumatic brain injury (TBI); however, the available data in paediatric populations are scarce. Here, we report the results of a prospective, long-term study in children, adolescents and young adults.

Study group

Thirty-seven children (age, 2 months to 19·9 years) of 51 eligible patients were followed for 1 year. Clinical and baseline endocrine variables were assessed in all 3 and 12 months after TBI; children ≥ 6 years underwent two stimulation tests (glucagon stimulation and megatest).

Results

In the group ≥6 years, 11 of 23 patients (47·8%) had a subnormal GH peak 3 months after TBI that persisted in 8 of 23 patients (34%) after 1 year. The GH response showed no correlation with injury severity (GCS, Marshall classification). Growth velocity was normal in all patients, except for one. Body mass index (BMI) SDS increased significantly in the group with low GH response. A suboptimal cortisol was observed in 10 of 23 subjects, which normalized in all but three, 1 year thereafter. All patients but one showed a pubertal response to GnRH testing. No clinical or hormonal abnormalities were detectable in children <6 years.

Conclusion

Our results recommend to prospectively follow children after TBI: firstly, because the impairment of pituitary function cannot be predicted, and secondly, to avoid the potential consequences of pituitary dysfunction. Prospective clinical trials are needed before recommending a systematic screening after TBI and/or GH therapy either in postpubertal children or in prepubertal children who grow normally.

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