Is routine endocrine evaluation necessary after paediatric traumatic brain injury?
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Traumatic brain injury (TBI) is a common event in childhood. It is a recognised cause of hypopituitarism both in adult and paediatric patients. Routine endocrine evaluation has been proposed for adult TBI-survivors; nevertheless, incongruous data have been reported in children.
The goal of this study was to describe the prevalence of pituitary dysfunction after TBI in a cohort of children.
Material/subjects and methods
This is a cross-sectional study comprising retrospective medical record review and prospective testing. Children with brain injury discharged from the Paediatric Intensive Care Unit from year 2004 to 2009 were recruited. Height and weight were recorded, systemic examination was performed and baseline pituitary function tests were undertaken. Provocative tests were performed only if abnormal basal levels were detected.
Thirty-six patients were collected; the mean age at assessment was 7.2 years and the mean interval since injury 3.3 years. All patients had skull fracture or intracranial haemorrhage; 36.6 % of them had moderate to severe TBI. No abnormalities were found on examination. Low serum IGF 1 levels were detected in four patients and two patients had low serum cortisol levels with inappropriately normal plasma ACTH concentrations. No evidence of pituitary dysfunction was observed in these patients after clinical follow-up, repeated baseline hormone levels or dynamic function tests.
No endocrine sequelae have been detected in this population. The routine endocrine evaluation in children with mild to moderate TBI might not be justified, according to our findings.
KeywordsHypopituitarism Traumatic brain injury Children Pituitary gland Endocrine investigations
Traumatic brain injury
Paediatric Intensive Care Unit
Growth hormone deficiency
Glasgow Coma Scale
Standard deviation score
The authors thank Paloma Jiménez for her excellent technical assistance, Dr Maria Angeles Aniel-Quiroga for her technical support and advice and Dr Pedro Martul for his expertise and very helpful comments on the manuscript.
Conflict of interest
The authors M.A. Salomón-Estébanez, G. Grau, A. Vela, A. Rodríguez, E. Morteruel, L. Castaño, and I. Rica declare that they have no conflict of interest.
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