Research Reports - Hypopituitarism in pediatric survivors of inflicted traumatic brain injury

J Neurotrauma. 2013 Sep 12

Auble B, Rose S, Bollepalli S, Weis T, Makoroff K, Khoury J, Colliers T.

Endocrine dysfunction is common after accidental traumatic brain injury.
Prevalence of endocrine dysfunction after inflicted traumatic brain injury (iTBI)
is not known. Objective was to examine endocrinopathy in children after moderate
to severe iTBI. Children with prior iTBI (n=14) were evaluated for
growth/endocrine dysfunction, including anthropometric measurements and hormonal
evaluation [nocturnal growth hormone (GH), thyrotropin (TSH) surge, cortisol
(morning, low-dose adrenocorticotropin (ACTH) -stimulated), insulin-like growth
factor (IGF-I), IGF-binding protein (IGFBP3), free thyroxine (FT4), prolactin
(PRL), and serum/urine osmolality]. Analysis used Fisher's exact test and
Wilcoxon Rank Sum test as appropriate. 86% of subjects had endocrine dysfunction
with at least one abnormality, while 50% had two or more abnormalities,
significantly increased compared to 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 two may require growth hormone therapy. In
conclusion, children with history of iTBI show high risk for endocrine
dysfunction, including elevated prolactin and growth abnormalities. This effect
of inflicted TBI has not been well-described in the literature. Larger,
multi-center, prospective studies would provide more data to determine extent of
endocrine dysfunction in iTBI. We recommend that any child with history of iTBI
be followed closely for growth velocity and pubertal changes. If growth velocity
is slow, prolactin level and a full endocrine evaluation should be performed.

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