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Pituitary dysfunction after traumatic brain injury: are there definitive data in children?
  1. Paula Casano-Sancho1,2
  1. 1Pediatric Endocrinology Unit, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
  2. 2CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain. ESPE Membership
  1. Correspondence to Dr Paula Casano-Sancho, Pediatric Endocrinology Unit, Sant Joan de Déu Hospital, Passeig Sant Joan de Déu, Santa Rosa 39-57, Esplugues, Barcelona 08950, Spain; pcasano{at}hsjdbcn.org

Abstract

In the past decade, several studies in adults and children have described the risk of pituitary dysfunction after traumatic brain injury (TBI). As a result, an international consensus statement recommended follow-up on the survivors. This paper reviews published studies regarding hypopituitarism after TBI in children and compares their results. The prevalence of hypopituitarism ranges from 5% to 57%. Growth hormone (GH) and ACTH deficiency are the most common, followed by gonadotropins and thyroid-stimulating hormone. Paediatric studies have failed to identify risk factors for developing hypopituitarism, and therefore we have no tools to restrict screening in severe TBI. In addition, the present review highlights the lack of a unified follow-up and the fact that unrecognised pituitary dysfunction is frequent in paediatric population. The effect of hormonal replacement in patient recovery is important enough to consider baseline screening and reassessment between 6 and 12 months after TBI. Medical community should be aware of the risk of pituitary dysfunction in these patients, given the high prevalence of endocrine dysfunction already reported in the studies. Longer prospective studies are needed to uncover the natural course of pituitary dysfunction, and new studies should be designed to test the benefit of hormonal replacement in metabolic, cognitive and functional outcome in these patients.

  • pituitary dysfunction
  • hypopituitarism
  • traumatic brain injury

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Footnotes

  • Funding PC-S has research support from Sant Joan de Déu Hospital for this publication.

  • Competing interests PC-S hasreceived an Accesit grant for the best publication in 2013 from the Spanish Paediatric Endocrinology Foundation, sponsored by Merck.

  • Patient consent Parental/guardian consentobtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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