Research Reports - Update of endocrine dysfunction following pediatric traumatic brain injury

J Clin Med. 2015 Jul 31;4(8):1536-60

Reifschneider K(1), Auble BA(2), Rose SR(3)

Traumatic brain injuries (TBI) are common occurrences in childhood, often
resulting in long term, life altering consequences. Research into endocrine
sequelae following injury has gained attention; however, there are few studies in
children. This paper reviews the pathophysiology and current literature
documenting risk for endocrine dysfunction in children suffering from TBI.
Primary injury following TBI often results in disruption of the
hypothalamic-pituitary-adrenal axis and antidiuretic hormone production and
release, with implications for both acute management and survival. Secondary
injuries, occurring hours to weeks after TBI, result in both temporary and
permanent alterations in pituitary function. At five years after moderate to
severe TBI, nearly 30% of children suffer from hypopituitarism. Growth hormone
deficiency and disturbances in puberty are the most common; however, any part of
the hypothalamic-pituitary axis can be affected. In addition, endocrine
abnormalities can improve or worsen with time, having a significant impact on
children's quality of life both acutely and chronically. Since primary and
secondary injuries from TBI commonly result in transient or permanent
hypopituitarism, we conclude that survivors should undergo serial screening for
possible endocrine disturbances. High indices of suspicion for life threatening
endocrine deficiencies should be maintained during acute care. Additionally,
survivors of TBI should undergo endocrine surveillance by 6-12 months after
injury, and then yearly, to ensure early detection of deficiencies in hormonal
production that can substantially influence growth, puberty and quality of life.

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