Evaluation of pituitary function after traumatic brain injury in childhood

Sophie N Khadr (1) , Patricia M Crofton (2) , Patricia Jones (3) , Barbara Wardhaugh (4) , Jennifer Roach (4) , Amanda Drake (3) , Robert Minns (3) , Christopher J H Kelnar (3)

1 General & Adolescent Paediatrics
2 Paediatric Biochemistry
3 Section of Child Life and Health
4 Paediatric Endocrinology

Objectives: Post-traumatic hypopituitarism is well described among adult traumatic brain injury survivors. We aimed to determine the prevalence and clinical significance of pituitary dysfunction after head injury in childhood. Design: Retrospective exploratory study. Patients: 33 survivors of accidental head injury (27 males). Mean (range) age at study was 13.4y (5.4-21.7y) and median (range) interval since injury, 4.3y (1.4-7.8y). Functional outcome at study: 15 good recovery, 16 moderate disability, two severe disability. Measurements: Early morning urine osmolality and basal hormone evaluation were followed by the GnRH and insulin tolerance (n=25) or glucagon tests (if previous seizures, n=8). Subjects were not primed. Head injury details were extracted from patient records. Results: No subject had short stature (mean height SD score +0.50, range -1.57 to +3.00). Sub-optimal GH responses (<5 μg/L) occurred in 6 peri-pubertal males with height SD scores between -1.5 and +1.4 (one with slow growth on follow-up) and in one post-pubertal male (3.2 μg/L). Median peak cortisol responses to insulin tolerance or glucagon tests were 538 and 562 nmol/L. 9/25 and 2/8 subjects had sub-optimal responses respectively, two with high basal cortisol levels. None required routine glucocorticoid replacement. In three, steroid cover was recommended for moderate/severe illness or injury. One male was prolactin deficient. Other basal endocrine results and GnRH-stimulated LH and FSH were appropriate for age, sex and pubertal stage. Abnormal endocrine findings were unrelated to the severity or other characteristics of TBI, or functional outcome. Conclusions: No clinically significant endocrinopathy was identified amongst survivors of accidental childhood TBI, although minor pituitary hormone abnormalities were observed.

Mots clés: Medicine

Sophie N Khadr, Patricia M Crofton, Patricia Jones, Barbara Wardhaugh, Jennifer Roach, et al.. Evaluation of pituitary function after traumatic brain injury in childhood. Clinical Endocrinology, 2010, 73 (5), pp.637. ⟨10.1111/j.1365-2265.2010.03857.x⟩. ⟨hal-00561819⟩