Research Reports - Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury

Pituitary. 2013 Dec;16(4):499-506

Bellone S, Einaudi S, Caputo M, Prodam F, Busti A, Belcastro S, Parlamento S, Zavattaro M, Verna F, Bondone C, Tessaris D, Gasco V, Bona G, Aimaretti G

To assess the incidence of abnormal neuroendocrine function post-traumatic brain
injuriy (TBI) in a large group of paediatric patients and its correlations with
clinical parameters (Glasgow coma scale-GCS, Glasgow outcome scale-GOS, TC
marshall scale, height velocity). We evaluated 70 patients [58 M, 12 F; age at
the time of TBI (mean ± SEM) 8.12 ± 4.23 years] previously hospitalized for TBI
at the "Regina Margherita" Hospital, in Turin and "Maggiore della Carità
Hospital" in Novara, Italy, between 1998 and 2008. All patients included
underwent: auxological, clinical, hormonal and biochemical assessments at recall
(after at least 1 year from TBI to T0); auxological visit after 6 months (T6) and
hormonal assessments at 12 months (T12) in patients with height velocity (HV)
below the 25th centile. At T0, 4 cases of hypothalamus-pituitary dysfunction had
been diagnosed; At T6 20/70 patients had an HV <25th centile, but no one had HV <
the 3rd centile limit. At T12, among the 20 patients with HV <25th centile, in 13
patients the HV was below the 25th centile and GHRH + Arginine test has been
performed. Four subjects demonstrated an impaired GH peak and were classified as
GH deficiency (GHD). Of these 4 subjects, 3 subjects showed isolated GHD, while
one patient showed multiple hypopituitarism presenting also secondary
hypocortisolism and hypothyroidism. The GCS at admission and GOS do not correlate
with the onset of hypopituitarism. A simple measurement of the height velocity at
least 1 year after the TBI, is enough to recognize patients with a pituitary
impairment related to GH deficiency. We suggest to follow-up paediatric
population who had TBI with auxological evaluations every 6 months, limiting
hormonal evaluation in patients with a reduction of height velocity below the
25th centile limit.

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