Research Reports - Is routine endocrine evaluation necessary after paediatric traumatic brain injury?
J Endocrinol Invest. 2014 Feb;37(2):143-8
Salomón-Estébanez MA(1), Grau G, Vela A, Rodríguez A, Morteruel E, Castaño L, Rica I
BACKGROUND: 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.
AIM: 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.
RESULTS: 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.
CONCLUSIONS: 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.