ESPE Abstracts

Background: Neuroendocrine disorders after traumatic brain injury (TBI) are found in 30-70 % of adults after TBI as reported 2011 in a German study with 1242 patients. Consecutive hormonal dysfunction may markedly impair thyroid and adrenal gland functions, which may put patients at risk if it remains unrecognized. Unfortunately, in the German database no children were included. However, endocrine disorders after SHT are also found in children, as the international data shows. In the current German pediatric surgery guidelines on TBI in children and adolescents (2022) it is noticed that endocrine deficiencies of TBI are not examined in a standardized procedure.

Objectives: Our principal object was the identification of young patients afflicted by moderate or severe TBI developing endocrine dysfunction in the course of the follow-up period. In the long term, the aim is to develop recommendations for the general endocrine follow-up of children aged 0-17 years after moderate and severe TBI.

Methods: Children and adolescents were examined in the first 14 days after TBI, as well as 3, 6, 12, 24 and 36 months later. Patient's medical history was taken by a detailed questionnaire for family and personal anamnesis, the actual physical and mental limitations were documented. We realized a detailed physical examination, including pubertal and neurological status, calculated height velocity, and performed laboratory examinations of the hypothalamus-pituitary axis.

Results: Since 2017 until 2023 50 patients (70 % male; age: 8, 6 ± 5, 6 [mean ± SD]) were included into the study. The proportion of severe craniocerebral trauma in the cohort regarding the GCS and the injury pattern is about 38 %. In 36% of cases, no initial GCS was recorded. Endocrine disorders in our patient cohort right after the TBI were central hypothyroidism (26 %), transient adrenal insufficiency (6 %) and pubertal disorders (4 %). 1 year after TBI, hypothyroidism was found in 6 %, adrenal insufficiency in 10 % and pubertal disorders in 8 % of the study participants. During the follow-up period, no growth hormone deficiency, no SIADH and no diabetes insipidus occurred. Neurological disorders occurred in 52% of the patients; only 28 % of them attended a rehabilitation center.

Conclusion: Pituitary disorders after TBI in childhood are prevalent, so that a follow-up after discharge from hospital is necessary. Complementary guidelines need to be composed to standardize the procedure directly after TBI and to provide adequate support for affected patients.