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Pituitary function in children following infectious diseases of the central nervous system

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Abstract

Recent studies in adults suggest that pituitary deficiencies develop in a considerable proportion of patients who recover from infectious meningitis. The aim of this study was to evaluate pituitary function of children with a history of meningitis. Seventy-nine children were admitted to the Safra Children’s Hospital due to meningitis between 2007 and 2010. Twenty-four families were lost for follow-up, 55 were interviewed by phone and 14 (9 males) participated in the study. Evaluation included medical history, physical examination, auxological measurements and basal levels of TSH, fT4, cortisol and IGF1. Children with abnormal results were followed for a year and dynamic testing was performed when indicated. Mean age at time of infectious meningitis was 3.8 ± 5.4 years (range 0.03–15.8), and at clinical evaluation 6.4 ± 6.4 (range 1.2–20). The interval between the acute event and evaluation was 2.7 ± 1.2 years. Thyroid function tests and basal cortisol levels were normal for all children. Three children had low IGF1 levels; however over a year of follow-up two of them had normal height and growth velocity, making growth hormone deficiency unlikely. One child had low height SDS, but exhibited a normal response to a growth hormone stimulation test. Pituitary dysfunction with overt clinical symptoms is not a frequent consequence of acute meningitis in children. Follow-up of growth and puberty of children post-meningitis by the primary care physician is probably sufficient. Invasive assessments should be reserved for selected cases where there is slow growth or other clinical suspicion of hypopituitarism.

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Abbreviations

CNS:

Central nervous system

TBI:

Traumatic brain injury

CSF:

Cerebrospinal fluid

TSH:

Thyrotropin

fT4:

Free thyroxin

IGF1:

Insulin-like growth factor-1

GH:

Growth hormone

FSH:

Follicle-stimulating hormone

LH:

Luteinizing hormone

APA:

Anti-pituitary antibodies

AHA:

Anti-hypothalamus antibodies

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Authors and Affiliations

  1. Pediatric Endocrine and Diabetes Unit, Safra Children’s Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel

    Yael Levy-Shraga, Inbal Gazit, Dalit Modan-Moses & Orit Pinhas-Hamiel

  2. Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Yael Levy-Shraga, Inbal Gazit, Dalit Modan-Moses & Orit Pinhas-Hamiel

Authors
  1. Yael Levy-Shraga
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  2. Inbal Gazit
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  3. Dalit Modan-Moses
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  4. Orit Pinhas-Hamiel
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Correspondence to Yael Levy-Shraga.

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Levy-Shraga, Y., Gazit, I., Modan-Moses, D. et al. Pituitary function in children following infectious diseases of the central nervous system. Pituitary 17, 118–124 (2014). https://doi.org/10.1007/s11102-013-0476-2

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  • DOI: https://doi.org/10.1007/s11102-013-0476-2

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