Skip to main content

Advertisement

SpringerLink
Log in

Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective

  • Published:
Pituitary Aims and scope Submit manuscript

Abstract

In survivors of traumatic brain injury (TBI), impairment in anterior pituitary hormone function may be an important cause of long-term morbidity. Histopathological evidence from post-mortem studies suggests that the hypothalamic-pituitary structures are vulnerable to damage following head injury. Pituitary dysfunction, present months or years after injury, is now well recognised in adults, however, little evidence is known about this potential complication in children and adolescents. This article reviews the available paediatric data, which shows that hypopituitarism may occur after both mild and severe TBI, with growth hormone and gonadotrophin deficiencies appearing to be most common abnormalities. Central precocious puberty has also been documented. There are, however, few published data within a population of children with TBI on the incidence or prevalence of hypopituitarism, nor on its natural history or response to hormone replacement, and prospective studies are needed. Given the critical role of anterior pituitary hormones in the regulation of growth, pubertal and neurocognitive development in childhood, early detection of hormone abnormalities following TBI is important. We propose that a multidisciplinary approach to follow-up and endocrine assessment is required for the long-term management and rehabilitation of children and adolescents who survive moderate to severe head injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Agha A, Rogers B, Mylotte D, Taleb F, Tormey W, Phillips J et al (2004) Neuroendocrine dysfunction in the acute phase of traumatic brain injury. Clin Endocrinol (Oxf) 60(5):584–591

    Article  CAS  Google Scholar 

  2. Della Corte F, Mancini A, Valle D, Gallizzi F, Carducci P, Mignani V et al (1998) Provocative hypothalamopituitary axis tests in severe head injury: correlations with severity and prognosis. Crit Care Med 26(8):1419–1426

    Article  PubMed  CAS  Google Scholar 

  3. Woolf PD (1992) Hormonal responses to trauma. Crit Care Med 20(2):216–226

    Article  PubMed  CAS  Google Scholar 

  4. Van den Berghe G (2000) Novel insights into the neuroendocrinology of critical illness. Eur J Endocrinol 143(1):1–13

    Article  PubMed  Google Scholar 

  5. Parslow RC, Morris KP, Tasker RC, Forsyth RJ, Hawley CA (2005) Epidemiology of traumatic brain injury in children receiving intensive care in the UK. Arch Dis Child 90(11):1182–1187

    Article  PubMed  CAS  Google Scholar 

  6. Tasker RC, Morris KP, Forsyth RJ, Hawley CA, Parslow RC (2006) Severe head injury in children: emergency access to neurosurgery in the United Kingdom. Emerg Med J 23(7):519–522

    Article  PubMed  CAS  Google Scholar 

  7. Mooney DP, Forbes P (2004) Trends in inpatient pediatric trauma care in new England. J Trauma 57(6):1241–1245

    PubMed  Google Scholar 

  8. Holbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise M, Anderson JP (2005) Long-term posttraumatic stress disorder persists after major trauma in adolescents: new data on risk factors and functional outcome. J Trauma 58(4):764–769; Discussion 769–771

    Google Scholar 

  9. Benoit R, Watts DD, Dwyer K, Kaufmann C, Fakhry S (2000) Windows 99: a source of suburban pediatric trauma. J Trauma 49(3):477–481

    PubMed  CAS  Google Scholar 

  10. Barlow KM, Minns RA (2000) Annual incidence of shaken impact syndrome in young children. Lancet 356(9241):1571–1572

    Article  PubMed  CAS  Google Scholar 

  11. McCarthy ML, MacKenzie EJ, Durbin DR, Aitken ME, Jaffe KM, Paidas CN et al (2006) Health-related quality of life during the first year after traumatic brain injury. Arch Pediatr Adolesc Med 160(3):252–260

    Article  PubMed  Google Scholar 

  12. Keenan HT, Runyan DK, Nocera M (2006) Longitudinal follow-up of families and young children with traumatic brain injury. Pediatrics 117(4):1291–1297

    Article  PubMed  Google Scholar 

  13. Mazaux JM, Richer E (1998) Rehabilitation after traumatic brain injury in adults. Disabil Rehabil 20(12):435–447

    Article  PubMed  CAS  Google Scholar 

  14. Colantonio A, Dawson DR, McLellan BA (1998) Head injury in young adults: long-term outcome. Arch Phys Med Rehabil 79(5):550–558

    Article  PubMed  CAS  Google Scholar 

  15. Crompton MR (1971) Hypothalamic lesions following closed head injury. Brain 94(1):165–172

    Article  PubMed  CAS  Google Scholar 

  16. Daniel PM, Prichard MM, Treip CS (1959) Traumatic infarction of the anterior lobe of the pituitary gland. Lancet 2:927–931

    Article  PubMed  CAS  Google Scholar 

  17. Harper CG, Doyle D, Adams JH, Graham DI (1986) Analysis of abnormalities in pituitary gland in non-missile head injury: study of 100 consecutive cases. J Clin Pathol 39(7):769–773

    Article  PubMed  CAS  Google Scholar 

  18. Cyran E (1918) Hypophysenschadiagung durch Schadelbasisfraktur. Dtsch Med Wschr 44:1261

    Google Scholar 

  19. Escamilla R, Lisser H (1942) Simmonds disease. J Clin Endocrinol 2:65–96

    Article  Google Scholar 

  20. Edwards OM, Clark JD (1986) Post-traumatic hypopituitarism. Six cases and a review of the literature. Medicine (Baltimore) 65(5):281–290

    CAS  Google Scholar 

  21. Benvenga S, Campenni A, Ruggeri RM, Trimarchi F (2000) Clinical review 113: hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 85(4):1353–1361

    Article  PubMed  CAS  Google Scholar 

  22. Agha A, Thompson CJ (2006) Anterior pituitary dysfunction following traumatic brain injury (TBI). Clin Endocrinol (Oxf) 64(5):481–488

    Article  Google Scholar 

  23. Popovic V, Aimaretti G, Casanueva FF, Ghigo E (2005) Hypopituitarism following traumatic brain injury. Growth Horm IGF Res 15(3):177–184

    Article  PubMed  CAS  Google Scholar 

  24. Kelly DF, Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C (2000) Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg 93(5):743–752

    PubMed  CAS  Google Scholar 

  25. Lieberman SA, Oberoi AL, Gilkison CR, Masel BE, Urban RJ (2001) Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 86(6):2752–2756

    Article  PubMed  CAS  Google Scholar 

  26. Bondanelli M, De Marinis L, Ambrosio MR, Monesi M, Valle D, Zatelli MC et al (2004) Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 21(6):685–696

    Article  PubMed  Google Scholar 

  27. Aimaretti G, Ambrosio MR, Di Somma C, Gasperi M, Cannavo S, Scaroni C, et al. (2005) Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J Clin Endocrinol Metab 90(11):6085–6092

    Article  PubMed  CAS  Google Scholar 

  28. Agha A, Rogers B, Sherlock M, O’Kelly P, Tormey W, Phillips J et al (2004) Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 89(10):4929–4936

    Article  PubMed  CAS  Google Scholar 

  29. Agha A, Sherlock M, Phillips J, Tormey W, Thompson CJ (2005) The natural history of post-traumatic neurohypophysial dysfunction. Eur J Endocrinol 152(3):371–377

    Article  PubMed  CAS  Google Scholar 

  30. Tanriverdi F, Senyurek H, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F (2006) High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma. J Clin Endocrinol Metab 91(6):2105–2111

    Article  PubMed  CAS  Google Scholar 

  31. Acerini CL, Tasker RC, Bellone S, Bona G, Thompson CJ, Savage MO (2006) Hypopituitarism in childhood and adolescence following traumatic brain injury: the case for prospective endocrine investigation. Eur J Endocrinol 155(5):663–669

    Article  PubMed  CAS  Google Scholar 

  32. Paxson CL, Brown DR (1976) Post-traumatic anterior hypopituitarism. Pediatrics 57(6):893–896

    PubMed  Google Scholar 

  33. Girard J, Marelli R (1977) Posttraumatic hypothalamo-pituitary insufficiency. Diagnostic and therapeutic problems in a prepubertal child. J Pediatr 90(2):241–242

    Article  PubMed  CAS  Google Scholar 

  34. Grossman WF, Sanfield JA (1994) Hypothalamic atrophy presenting as amenorrhea and sexual infantilism in a female adolescent. A case report. J Reprod Med 39(9):738–740

    PubMed  CAS  Google Scholar 

  35. Valenta LJ, De Feo DR (1980) Post-traumatic hypopituitarism due to a hypothalamic lesion. Am J Med 68(4):614–617

    Article  PubMed  CAS  Google Scholar 

  36. Surtees R, Adams J, Price D, Clayton P, Shalet S (1987) Association of adverse perinatal events with an empty sella turcica in children with growth hormone deficiency. Horm Res 28(1):5–12

    PubMed  CAS  Google Scholar 

  37. Miller WL, Kaplan SL, Grumbach MM (1980) Child abuse as a cause of post-traumatic hypopituitarism. N Engl J Med 302(13):724–728

    Article  PubMed  CAS  Google Scholar 

  38. Yamanaka C, Momoi T, Fujisawa I, Kikuchi K, Kaji M, Sasaki H et al (1993) Acquired growth hormone deficiency due to pituitary stalk transection after head trauma in childhood. Eur J Pediatr 152(2):99–101

    Article  PubMed  CAS  Google Scholar 

  39. Barbeau C, Jouret B, Gallegos D, Sevely A, Manelfe C, Oliver I et al (1998) Pituitary stalk transection syndrome. Arch Pediatr 5(3):274–279

    Article  PubMed  CAS  Google Scholar 

  40. Benvenga S, Vigo T, Ruggeri RM, Lapa D, Almoto B, LoGiudice F et al (2004) Severe head trauma in patients with unexplained central hypothyroidism. Am J Med 116(11):767–771

    Article  PubMed  Google Scholar 

  41. Mariani R, Bortoluzzi MN, Richelme C, El Barbary M, Coussement A (1996) Post-traumatic hypopituitarism after skull injury: apropos of 3 cases. Arch Pediatr 3(8):796–801

    Article  PubMed  CAS  Google Scholar 

  42. LaFranchi SH (1979) Sexual precocity with hypothalamic hypopituitarism. Am J Dis Child 133(7):739–742

    PubMed  CAS  Google Scholar 

  43. Shaul PW, Towbin RB, Chernausek SD (1985) Precocious puberty following severe head trauma. Am J Dis Child 139(5):467–469

    PubMed  CAS  Google Scholar 

  44. Sockalosky JJ, Kriel RL, Krach LE, Sheehan M (1987) Precocious puberty after traumatic brain injury. J Pediatr 110(3):373–377

    Article  PubMed  CAS  Google Scholar 

  45. Blendonohy PM, Philip PA (1991) Precocious puberty in children after traumatic brain injury. Brain Inj 5(1):63–68

    PubMed  CAS  Google Scholar 

  46. Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr (2005) Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 103(3):448–454

    Article  PubMed  Google Scholar 

  47. Agha A, Thornton E, O’Kelly P, Tormey W, Phillips J, Thompson CJ (2004) Posterior pituitary dysfunction after traumatic brain injury. J Clin Endocrinol Metab 89(12):5987–5992

    Article  PubMed  CAS  Google Scholar 

  48. Barzilay Z, Somekh E (1988) Diabetes insipidus in severely brain damaged children. J Med 19(1):47–64

    PubMed  CAS  Google Scholar 

  49. Einaudi S, Matarazzo P, Peretta P, Grossetti R, Giordano F, Altare F, Bondone C, Andreo M, Ivani G, Genitori L, de Sanctis C (2006) Hypothalamo-hypophysial dysfunction after traumatic brain injury in children and adolescents: a preliminary retrospective and prospective study. J Pediatr Endocrinol Metabol 19:691–703

    CAS  Google Scholar 

  50. Niederland T, Makovi H, Gal V, Andreka B, Abraham CS, Kovacs J (2007) Abnormalities of pituitary function after traumatic brain injury in children. J Neurotrauma 24(1):119–127

    Article  PubMed  Google Scholar 

  51. Leal-Cerro A, Flores JM, Rincon M, Murillo F, Pujol M, Garcia-Pesquera F, Dieguez C, Casanueva FF (2005) Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury. Clin Endocrinol (Oxf) 62(5):525–532

    Article  CAS  Google Scholar 

  52. Aimaretti G, Ambrosio MR, Di Somma C, Fusco A, Cannavo S, Gasperi M et al (2004) Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 61(3):320–326

    Article  CAS  Google Scholar 

  53. Eichler I, Frisch H, Eichler HG, Soukop W (1998) Isolated growth hormone deficiency after severe head trauma. J Endocrinol Invest 11:409–411

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, University of Cambridge, Addenbrooke’s Hospital, Level 8/Box 116, Cambridge, CB2 2QQ, UK

    Carlo L. Acerini & Robert C. Tasker

Authors
  1. Carlo L. Acerini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. Tasker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlo L. Acerini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Acerini, C.L., Tasker, R.C. Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective. Pituitary 10, 373–380 (2007). https://doi.org/10.1007/s11102-007-0052-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11102-007-0052-8

Keywords

Search

Navigation