Background: In recent years, traumatic brain injury (TBI) has been identified as a significant cause of pituitary dysfunction in children. Paediatric prospective studies are rare especially for mild TBI.
Objective and hypotheses: The aim of this present study was to evaluate the frequency of hypopituitarism after mild, moderate and severe TBI in hospitalized children, and determining factors of this deficiency.
Method: A prospective study was conducted for children from 2 to 18 years old, hospitalised after TBI between September 2009 and June 2013. Clinical parameters, basal pituitary hormone concentration at 0, 6 and 12 months and a dynamic test at 12 months after TBI were performed (insulin tolerance test or glucagon test if contra indicates for assessment of somatotropic and corticotropic axes), confirm by a second test in case of GH insufficiency.
Results: 117 patients, sex ratio H/F 79/38, median age 7.6 years (range 2 to 17.8 years). Distribution plot shows 109 mild, four moderate and four severe TBI, according to Glasgow Coma Scale. Pituitary insufficiencies (PI) were present in 43 (37%) children at 12 months after TBI. Six of them have two or more hormonal deficits. 30 and 50 children have a secondary adrenal insufficiency (SAI) and GH deficiency (GHD) respectively, after insulin tolerance test. Confirmed GHD was present in 15 cases. GHD were severe in two children but only one have low velocity rate. One gonadotropin, five prolactin, and no TSH insufficiency nor central precocious puberty were observed at 12 months after TBI.
Conclusion: Biological PI is present in 37% of TBI even if majority of patient have mild TBI. Interrogation persists in clinical relevance of biological GHD because velocity rate is often conserved. However, practitioner should keep in watch children growth, tiredness and puberty after TBI whatever its severity.
Conflict of interest: This study received a financial support from IPSEN.
Funding: This study received a financial helps from IPSEN.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology