Research Reports - Prevalence of pituitary dysfunction following traumatic brain injury in children and adolescents

J Clin Endocrinol Metab. 2014 Mar 17

Personnier C(1), Crosnier H, Meyer P, Chevignard M, Flechtner I, Boddaert N, Breton S, Mignot C, Dassa Y, Souberbielle JC, Piketty M, Laborde K, Jais JP, Viaud M, Puget S, Sainte-Rose C, Polak M

Context. Traumatic brain injury (TBI) in childhood is a major public health
issue. Objective. We sought to determine the prevalence of pituitary dysfunction
in children and adolescents after severe TBI and to identify any potential
predictive factors. Design. Prospective longitudinal study. Setting. A University
Hospital. Patients. Patients, hospitalized for severe accidental or inflicted
TBI, were included. The endocrine assessment was performed between 6 and 18
months post-injury. Main Outcome Measures. Basal and dynamic tests of pituitary
function were performed in all patients and growth hormone (GH) dynamic testing
was repeated in patients with low stimulated GH peak (< 7 ng/ml). The diagnosis
of proven severe GH deficiency (GHD) was based on the association of two GH peaks
<5 ng/ml on both occasion of testing and IGF-1 levels below -2 SDS. Initial
computed tomography (CT) or magnetic resonance imaging (MRI) were analyzed
retrospectively. Results. We studied 87 children and adolescents (60 males,
median age of 6.7 years [range: 0.8-15.2]) 9.5±3.4 months post-TBI (73
accidental, 14 inflicted). The second GH peak, assessed 4.9±0.1 months after the
first evaluation, remained low in 27 children and adolescents. Fifteen patients
had GH peak <5 ng/ml (mean IGF-1 SDS -1.3±1.5) and five (5.7%) strict criteria
for severe GHD. Two children had mild central hypothyroidism and one had ACTH
deficiency. We did not find any predictive factors associated with existence of
GHD (demographic characteristics, growth velocity, trauma severity and
radiological parameters). Conclusion: At one year post-severe TBI, pituitary
dysfunction was found in 8% of our study sample. We recommend systematic hormonal
assessment in children and adolescents 12 months after severe TBI and prolonged
clinical endocrine follow-up.

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