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 (315) and Marshall Classification (LEDIVI). 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 (LEDIIVI) 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.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology