ESPE Abstracts

Background: Traumatic brain injury (TBI) is a frequent cause of endocrine dysfunctions. However, studies in children are scarce.

Objective and hypotheses: To determine pituitary function in children after TBI. To analyze risk factors related with endocrine dysfunctions after 12 months follow up.

Method: A prospective study of endocrine function in children after head injury was performed. Data was collected for baseline Glasgow coma score (3–15) and Marshall Classification (LEDI–VI). Patients were evaluated within 72 h of head injury, and 6 and 12 months thereafter. Physical exam, bone age and basal hormone levels (TSH, fT₄, ACTH, cortisol, prolactin, IGF1, and IGFBP3) were assessed at each visit. When necessary, dynamic tests were performed to confirm endocrine dysfunctions.

Results: Of 52 patients initially enrolled, the study was completed by 36 (mean age 5.9 years). TBIs were classified as moderate or severe in 16.7% of cases, 44% presented intracranial injury, and 5.6% required surgery. Baseline hormonal assessment was abnormal in 12 patients (33.4%), diminishing to 19.5 and 16.7 at 6 and 12 months respectively. One patient with severe TBI initially developed multiple endocrine dysfunction requiring treatment for diabetes insipidus at 12 month follow-up. Our data show that intracranial injury (LEDII–VI) is associated to a three fold risk of endocrine dysfunction at baseline assessment (P 0.038). Furthermore, hormone dysfunction at 6 months of follow-up may predict the risk of developing dysfunctions at 12 months (P 0.052).

Conclusion: In our study, intracranial injury is related to higher risk of endocrine dysfunctions at admission time. During follow-up, most hormone dysfunctions were transitory and of uncertain clinical importance. However, one patient still required treatment after 12 months of TBI. Risk factors predicting the development of long-term endocrine dysfunctions could not be assigned. Further studies are in progress.