title: Hypopituitarism in pediatric survivors of inflicted traumatic brain injury.
abstract: Endocrine dysfunction is common after accidental traumatic brain injury (TBI). Prevalence of endocrine dysfunction after inflicted traumatic brain injury (iTBI) is not known. The aim of this study was to examine endocrinopathy in children after moderate-to-severe iTBI. Children with previous iTBI (n=14) were evaluated for growth/endocrine dysfunction, including anthropometric measurements and hormonal evaluation (nocturnal growth hormone [GH], thyrotropin surge, morning and low-dose adrenocorticotropin stimulated cortisol, insulin-like growth factor 1, IGF-binding protein 3, free thyroxine, prolactin [PRL], and serum/urine osmolality). Analysis used Fisher's exact test and Wilcoxon's rank-sum test, as appropriate. Eighty-six percent of subjects had endocrine dysfunction with at least one abnormality, whereas 50% had two or more abnormalities, significantly increased compared to an estimated 2.5% with endocrine abnormality in the general population (p<0.001). Elevated prolactin was common (64%), followed by abnormal thyroid function (33%), short stature (29%), and low GH peak (17%). High prolactin was common in subjects with other endocrine abnormalities. Two were treated with thyroid hormone and 2 may require GH therapy. In conclusion, children with a history of iTBI show high risk for endocrine dysfunction, including elevated PRL and growth abnormalities. This effect of iTBI has not been well described in the literature. Larger, multi-center, prospective studies would provide more data to determine the extent of endocrine dysfunction in iTBI. We recommend that any child with a history of iTBI be followed closely for growth velocity and pubertal changes. If growth velocity is slow, PRL level and a full endocrine evaluation should be performed.
authors.affiliation: 1 Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine , Cincinnati, Ohio.
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Auble
authors.forename: Sureka
authors.initials: S
authors.lastname: Bollepalli
authors.forename: Kathi
authors.initials: K
authors.lastname: Makoroff
authors.forename: Tammy
authors.initials: T
authors.lastname: Weis
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Tracy
authors.initials: T
authors.lastname: Colliers
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rose
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D002648:Child; D002649:Child Abuse; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000209:etiology; D013006:Growth Hormone / Q000627:therapeutic use; D006760:Hospitalization; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D010901:Pituitary Function Tests; D010907:Pituitary Hormones / Q000097:blood; D011388:Prolactin / Q000097:blood; D038642:Shaken Baby Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D013534:Survival; D013959:Thyroid Diseases / Q000209:etiology; D013963:Thyroid Hormones / Q000097:blood / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D010907:Pituitary Hormones; D013963:Thyroid Hormones; D019382:Human Growth Hormone; D011388:Prolactin; D013006:Growth Hormone
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