Endocrine changes after pediatric traumatic brain injury
- 1.1k Downloads
Traumatic brain injury (TBI) is a very common occurrence in childhood, and can lead to devastating long term consequences. Recent research has focused on the potential endocrine consequences of TBI in adults. The research in children is less robust. This paper reviews current literature regarding TBI and possible hypothalamic and pituitary deficiencies in childhood. Acute endocrine changes are commonly found after TBI in pediatric patients, which can include changes in hypothalamic–pituitary–adrenal axis and antidiuretic hormone production and release. In the long term, both temporary and permanent alterations in pituitary function have been found. About 30% of children have hypopituitarism up to 5 years after injury. Growth hormone deficiency and disturbances in puberty are the most common, but children can also experience ACTH deficiency, diabetes insipidus, central hypothyroidism, and elevated prolactin. Every hormonal axis can be affected after TBI in children, although growth hormone deficiency and alterations in puberty are the most common. Because transient and permanent hypopituitarism is common after TBI, survivors should be screened serially for possible endocrine disturbances. These children should undergo routine surveillance at least 1 year after injury to ensure early detection of deficiencies in hormonal production in order to permit normal growth and development.
KeywordsTraumatic brain injury Hypopituitarism Precocious puberty Hypogonadotropic hypogonadism Central hypothyroidism Growth hormone deficiency Adrenal insufficiency Hyperprolactinemia Adult Pediatric
This review would not have been possible without the diligent efforts of our colleagues Anne-Marie Kaulfers, Samantha Blum, Tammy Weis, Linda Michaud, and Kathi Makoroff.
- 10.Tanrverdi F, De Bellis A, Bizzarro A, Sinisi AA, Bellastella G, Pane E, Bellastella A, Unluhizarci K, Selcuklu A, Casanueva FF, Kelestimur F (2008) Antipituitary antibodies after traumatic brain injury: is head trauma-induced pituitary dysfunction associated with autoimmunity? Eur J Endocrinol 159:7–13CrossRefGoogle Scholar
- 11.Pavlovic D, Pekic S, Stojanovic M, Zivkovic V, Djurovic B, Jovanovic V, Miljic N, Medic-Stojanoska M, Doknic M, Miljic D, Djurovic M, Casanueva F, Popovic V (2010) Chronic cognitive sequelae after traumatic brain injury are not related to growth hormone deficiency in adults. Eur J Neurol 17:696–702PubMedCrossRefGoogle Scholar
- 12.Berg C, Oeffner A, Schumm-Draeger PM, Badorrek F, Brabant G, Gerbert B, Bornstein S, Zimmermann A, Weber M, Broecker-Preuss M, Mann K, Herrmann BL (2010) Prevalence of anterior pituitary dysfunction in patients following traumatic brain injury in a German multi-centre screening program. Exp Clin Endocrinol Diabetes 118:139–144PubMedCrossRefGoogle Scholar
- 21.Barzilay Z, Somekh E (1998) Diabetes insipidus in severely brain damaged children. J Med 19:47–64Google Scholar
- 22.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 91:2105–2111PubMedCrossRefGoogle Scholar
- 31.Bolado GG, Estebanez M, Arizkeuren EM, Calcena AA, Esteves AR, Vela A, Rica I (2011) Assessment of pituitary function after traumatic brain injury in childhood. Abstract P2-d1-680: European Society for Pediatric Endocrinology (ESPE), GlasgowGoogle Scholar
- 32.Aleksijevic D, Zapletalova J, Krahulik D, Klaskova E, Widermann J, Mihal V (2011) Endocrine dysfunction after traumatic brain injury in children and adolescents (a single centre prospective study). Abstract P2-d1-732: European Society for Pediatric Endocrinology (ESPE), GlasgowGoogle Scholar
- 33.Hewitt J, Pitkin J, Corbin V, Maixner W, Zacharin M (2011) Endocrine sequelae of traumatic brain injury in children: a prospective study. Abstract P1-d3-347: European Society for Pediatric Endocrinology (ESPE), GlasgowGoogle Scholar
- 46.Bourguignon JP, Gérard A, Purnelle G, Czajkowski V, Yamanaka C, Lemaître M, Rigo JM, Moonen G, Franchimont P (1997) Duality of glutamatergic and GABAergic control of pulsatile GnRH secretion by rat hypothalamic explants: II. Reduced NR2C- and GABAA-receptor-mediated inhibition at initiation of sexual maturation. J Neuroendocrinol 9(3):193–199PubMedCrossRefGoogle Scholar
- 48.Chiolero RL, Lemarchand-Beraud T, Schutz Y, de Tribolet N, Bayer-Berger M, Freeman J (1988) Thyroid function in severely traumatized patients with or without head injury. Acta Endocrinol (Copenh) 117:80–86Google Scholar