Permanent Hypopituitarism Is Rare after Structural Traumatic Brain Injury in Early Childhood

• Published in: The journal of clinical endocrinology and metabolism Vol. 97; no. 2; pp. 599 - 604
• Main Authors: Heather, Natasha L, Jefferies, Craig, Hofman, Paul L, Derraik, José G. B, Brennan, Christine, Kelly, Patrick, Hamill, James K. M, Jones, Rhys G, Rowe, Deborah L, Cutfield, Wayne S
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-02-2012; Copyright by The Endocrine Society
• Subjects: Age of Onset; Biological and medical sciences; Brain Injuries - complications; Brain Injuries - epidemiology; Child; Child, Preschool; Cross-Sectional Studies; Endocrinopathies; Feeding. Feeding behavior; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Hypopituitarism - epidemiology; Hypopituitarism - etiology; Hypothalamus. Hypophysis. Epiphysis (diseases); Infant; Infant, Newborn; Longitudinal Studies; Male; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Prevalence; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Human; Obesity; Nervous system diseases; Nutrition; Nutrition disorder; Metabolic diseases; Hypophyseal insufficiency; Pituitary diseases; Early; Head trauma; Child; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2011-2284

Background:
We sought to determine the incidence of permanent hypopituitarism in a potentially high-risk group: young children after structural traumatic brain injury (TBI).
Methods:
We conducted a cross-sectional study with longitudinal follow-up. Dynamic tests of pituitary function (GH and ACTH) were performed in all subjects and potential abnormalities critically evaluated. Puberty was clinically staged; baseline thyroid function, prolactin, IGF-I, serum sodium, and osmolality were compared with age-matched data. Diagnosis of GH deficiency was based on an integrated assessment of stimulated GH peak (<5 μg/liter suggestive of deficiency), IGF-I, and growth pattern. ACTH deficiency was diagnosed based on a subnormal response to two serial Synacthen tests (peak cortisol <500 nmol/liter) and a metyrapone test.
Results:
We studied 198 survivors of structural TBI sustained in early childhood (112 male, age at injury 1.7 ± 1.5 yr) 6.5 ± 3.2 yr after injury. Sixty-four of the injuries (33%) were inflicted and 134 (68%) accidental. Two participants had developed precocious puberty, which is within the expected background population rate. Peak stimulated GH was subnormal in 16 participants (8%), in the context of normal IGF-I and normal growth. Stimulated peak cortisol was low in 17 (8%), but all had normal ACTH function on follow-up. One participant had a transient low serum T4. Therefore, no cases of hypopituitarism were recorded.
Conclusion:
Permanent hypopituitarism is rare after both inflicted and accidental structural TBI in early childhood. Precocious puberty was the only pituitary hormone abnormality found, but the prevalence did not exceed that of the normal population.