Background: Traumatic brain injury (TBI) is common in childhood and can induce pituitary defects. Long-term endocrine consequences are missing.
Objective and hypotheses: To determine in a prospective way if pediatric patients with a personal history of TBI developed long term pituitary deficiency independently of the results of the early hormonal investigation.
Method: Prospective follow-up of an initial cohort of subjects (015 years old) with a personal history of severe TBI1. Clinical and hormonal evaluation at inclusion (first year after TBI) and at last visit.
Results: In total of 37 patients are actually included in the follow-up (29 boys, median age: 13.4 years (yrs), 5.3 to 20.9). Median duration of follow-up was 5.9 yrs (3.9 to 7.1). 20/37 had normal pituitary function at first evaluation (group 1) and 17/37 had GH deficiency (GHD) (group 2). In group 1, one patient developed GHD requiring substitution (10 yrs of age - 5.1 yrs post TBI) and one girl developed precocious puberty (PP) (7.85.8 yrs post TBI). In group 2, 2 patients with biological GHD but regular growth velocity developed growth failure and had to be treated (11.9 yrs and 12.3 yrs 4.3 and 5.1 yrs post TBI) and one boy developed PP (10 yrs 6.3 yrs post TBI). No new patients developed gonadotropic, thyreotropic or corticotrophic deficiency or insipidous diabetes during the follow-up in both groups.
Conclusion: Children with a personal history of TBI can developed a clinical expression of pituitary dysfunction even they had normal evaluation one year post-TBI. These results argue for a prolonged endocrine follow-up of those patients contrary to reports in adults. Supported in part by Pfizer SAS. 1Personnier and al, JCEM 2014.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology