Pituitary

, Volume 10, Issue 4, pp 373–380

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

Article

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.

Keywords

Traumatic brain injury Hypopituitarism Pituitary dysfunction Growth hormone deficiency 

References

  1. 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):584–591CrossRefGoogle Scholar
  2. 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):1419–1426PubMedCrossRefGoogle Scholar
  3. 3.
    Woolf PD (1992) Hormonal responses to trauma. Crit Care Med 20(2):216–226PubMedCrossRefGoogle Scholar
  4. 4.
    Van den Berghe G (2000) Novel insights into the neuroendocrinology of critical illness. Eur J Endocrinol 143(1):1–13PubMedCrossRefGoogle Scholar
  5. 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):1182–1187PubMedCrossRefGoogle Scholar
  6. 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):519–522PubMedCrossRefGoogle Scholar
  7. 7.
    Mooney DP, Forbes P (2004) Trends in inpatient pediatric trauma care in new England. J Trauma 57(6):1241–1245PubMedGoogle Scholar
  8. 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 769–771Google Scholar
  9. 9.
    Benoit R, Watts DD, Dwyer K, Kaufmann C, Fakhry S (2000) Windows 99: a source of suburban pediatric trauma. J Trauma 49(3):477–481PubMedGoogle Scholar
  10. 10.
    Barlow KM, Minns RA (2000) Annual incidence of shaken impact syndrome in young children. Lancet 356(9241):1571–1572PubMedCrossRefGoogle Scholar
  11. 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):252–260PubMedCrossRefGoogle Scholar
  12. 12.
    Keenan HT, Runyan DK, Nocera M (2006) Longitudinal follow-up of families and young children with traumatic brain injury. Pediatrics 117(4):1291–1297PubMedCrossRefGoogle Scholar
  13. 13.
    Mazaux JM, Richer E (1998) Rehabilitation after traumatic brain injury in adults. Disabil Rehabil 20(12):435–447PubMedCrossRefGoogle Scholar
  14. 14.
    Colantonio A, Dawson DR, McLellan BA (1998) Head injury in young adults: long-term outcome. Arch Phys Med Rehabil 79(5):550–558PubMedCrossRefGoogle Scholar
  15. 15.
    Crompton MR (1971) Hypothalamic lesions following closed head injury. Brain 94(1):165–172PubMedCrossRefGoogle Scholar
  16. 16.
    Daniel PM, Prichard MM, Treip CS (1959) Traumatic infarction of the anterior lobe of the pituitary gland. Lancet 2:927–931PubMedCrossRefGoogle Scholar
  17. 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):769–773PubMedCrossRefGoogle Scholar
  18. 18.
    Cyran E (1918) Hypophysenschadiagung durch Schadelbasisfraktur. Dtsch Med Wschr 44:1261Google Scholar
  19. 19.
    Escamilla R, Lisser H (1942) Simmonds disease. J Clin Endocrinol 2:65–96CrossRefGoogle Scholar
  20. 20.
    Edwards OM, Clark JD (1986) Post-traumatic hypopituitarism. Six cases and a review of the literature. Medicine (Baltimore) 65(5):281–290Google Scholar
  21. 21.
    Benvenga S, Campenni A, Ruggeri RM, Trimarchi F (2000) Clinical review 113: hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 85(4):1353–1361PubMedCrossRefGoogle Scholar
  22. 22.
    Agha A, Thompson CJ (2006) Anterior pituitary dysfunction following traumatic brain injury (TBI). Clin Endocrinol (Oxf) 64(5):481–488CrossRefGoogle Scholar
  23. 23.
    Popovic V, Aimaretti G, Casanueva FF, Ghigo E (2005) Hypopituitarism following traumatic brain injury. Growth Horm IGF Res 15(3):177–184PubMedCrossRefGoogle Scholar
  24. 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):743–752PubMedGoogle Scholar
  25. 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):2752–2756PubMedCrossRefGoogle Scholar
  26. 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):685–696PubMedCrossRefGoogle Scholar
  27. 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):6085–6092PubMedCrossRefGoogle Scholar
  28. 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):4929–4936PubMedCrossRefGoogle Scholar
  29. 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):371–377PubMedCrossRefGoogle Scholar
  30. 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):2105–2111PubMedCrossRefGoogle Scholar
  31. 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):663–669PubMedCrossRefGoogle Scholar
  32. 32.
    Paxson CL, Brown DR (1976) Post-traumatic anterior hypopituitarism. Pediatrics 57(6):893–896PubMedGoogle Scholar
  33. 33.
    Girard J, Marelli R (1977) Posttraumatic hypothalamo-pituitary insufficiency. Diagnostic and therapeutic problems in a prepubertal child. J Pediatr 90(2):241–242PubMedCrossRefGoogle Scholar
  34. 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):738–740PubMedGoogle Scholar
  35. 35.
    Valenta LJ, De Feo DR (1980) Post-traumatic hypopituitarism due to a hypothalamic lesion. Am J Med 68(4):614–617PubMedCrossRefGoogle Scholar
  36. 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):5–12PubMedGoogle Scholar
  37. 37.
    Miller WL, Kaplan SL, Grumbach MM (1980) Child abuse as a cause of post-traumatic hypopituitarism. N Engl J Med 302(13):724–728PubMedCrossRefGoogle Scholar
  38. 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):99–101PubMedCrossRefGoogle Scholar
  39. 39.
    Barbeau C, Jouret B, Gallegos D, Sevely A, Manelfe C, Oliver I et al (1998) Pituitary stalk transection syndrome. Arch Pediatr 5(3):274–279PubMedCrossRefGoogle Scholar
  40. 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):767–771PubMedCrossRefGoogle Scholar
  41. 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):796–801PubMedCrossRefGoogle Scholar
  42. 42.
    LaFranchi SH (1979) Sexual precocity with hypothalamic hypopituitarism. Am J Dis Child 133(7):739–742PubMedGoogle Scholar
  43. 43.
    Shaul PW, Towbin RB, Chernausek SD (1985) Precocious puberty following severe head trauma. Am J Dis Child 139(5):467–469PubMedGoogle Scholar
  44. 44.
    Sockalosky JJ, Kriel RL, Krach LE, Sheehan M (1987) Precocious puberty after traumatic brain injury. J Pediatr 110(3):373–377PubMedCrossRefGoogle Scholar
  45. 45.
    Blendonohy PM, Philip PA (1991) Precocious puberty in children after traumatic brain injury. Brain Inj 5(1):63–68PubMedGoogle Scholar
  46. 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):448–454PubMedCrossRefGoogle Scholar
  47. 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):5987–5992PubMedCrossRefGoogle Scholar
  48. 48.
    Barzilay Z, Somekh E (1988) Diabetes insipidus in severely brain damaged children. J Med 19(1):47–64PubMedGoogle Scholar
  49. 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 19:691–703Google Scholar
  50. 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):119–127PubMedCrossRefGoogle Scholar
  51. 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):525–532CrossRefGoogle Scholar
  52. 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):320–326CrossRefGoogle Scholar
  53. 53.
    Eichler I, Frisch H, Eichler HG, Soukop W (1998) Isolated growth hormone deficiency after severe head trauma. J Endocrinol Invest 11:409–411Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of PaediatricsUniversity of Cambridge, Addenbrooke’s HospitalCambridgeUK

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