title: Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolescents: a large prospective study.
abstract: BACKGROUND
  Traumatic brain injury (TBI) in childhood is a major public health issue.
  
  
  OBJECTIVE
  We sought to determine the prevalence of pituitary dysfunction in children and adolescents after severe TBI and to identify any potential predictive factors.
  
  
  METHODS
  This was a prospective longitudinal study.
  
  
  METHODS
  The study was conducted at a university hospital.
  
  
  METHODS
  Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months after the injury.
  
  
  METHODS
  Basal and dynamic tests of pituitary function were performed in all patients and GH dynamic testing was repeated in patients with low stimulated GH peak (<7 ng/mL). The diagnosis of proven severe GH deficiency (GHD) was based on the association of two GH peaks less than 5 ng/mL on both occasions of testing and IGF-I levels below -2 SD score. Initial cranial tomography or magnetic resonance imaging was analyzed retrospectively.
  
  
  RESULTS
  We studied 87 children and adolescents [60 males, median age 6.7 y (range 0.8-15.2)] 9.5 ± 3.4 months after the TBI (73 accidental, 14 inflicted). The second GH peak, assessed 4.9 ± 0.1 months after the first evaluation, remained low in 27 children and adolescents. Fifteen patients had a GH peak less than 5 ng/mL (mean IGF-I SD score -1.3 ± 1.5) and five (5.7%) strict criteria for severe GHD. Two children had mild central hypothyroidism and one had ACTH deficiency. We did not find any predictive factors associated with existence of GHD (demographic characteristics, growth velocity, trauma severity, and radiological parameters).
  
  
  CONCLUSIONS
  At 1 year after the severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after a severe TBI and prolonged clinical endocrine follow-up.
authors.affiliation: Pediatric Endocrinology, Gynecology, and Diabetology Unit (C.P., H.C., I.F., Y.D., M.V., M.P.), Pediatric Anesthesiology Unit (P.M.), Radiology Unit (N.B., S.B.), Pediatric Neurosurgery Unit (C.M., S.P., C.S.-R.), Functional Explorations Unit (J.-C.S., M.P., K.L.), and Biostatistics Department (J.-P.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker Enfants-Malades, 75015 Paris, France; Rehabilitation Department for Children With Acquired Neurological Injury (M.C.), Hôpitaux de St Maurice, 94410 St Maurice, France; Université Paris Descartes (N.B., S.B., S.P., C.S.-R., M.P.), 75014 Paris, France; ER6-Université Pierre et Marie Curie, 75252 Paris, France (M.C.); and IMAGINE Affiliate (N.B., M.P.), 75015 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Personnier
authors.forename: Hélène
authors.initials: H
authors.lastname: Crosnier
authors.forename: Philippe
authors.initials: P
authors.lastname: Meyer
authors.forename: Mathilde
authors.initials: M
authors.lastname: Chevignard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Flechtner
authors.forename: Nathalie
authors.initials: N
authors.lastname: Boddaert
authors.forename: Sylvain
authors.initials: S
authors.lastname: Breton
authors.forename: Caroline
authors.initials: C
authors.lastname: Mignot
authors.forename: Yamina
authors.initials: Y
authors.lastname: Dassa
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Souberbielle
authors.forename: Marie
authors.initials: M
authors.lastname: Piketty
authors.forename: Kathleen
authors.initials: K
authors.lastname: Laborde
authors.forename: Jean-Philipe
authors.initials: JP
authors.lastname: Jais
authors.forename: Magali
authors.initials: M
authors.lastname: Viaud
authors.forename: Stephanie
authors.initials: S
authors.lastname: Puget
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
authors.forename: Michel
authors.initials: M
authors.lastname: Polak
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000453:epidemiology*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D059906:Neuroimaging / Q000706:statistics & numerical data; D015995:Prevalence; D012720:Severity of Illness Index