Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment?

Summary Background Hypopituitarism has been widely described in adults after traumatic brain injury ( TBI ); however, the available data in paediatric populations are scarce. Here, we report the results of a prospective, long‐term study in children, adolescents and young adults. Study group Thirty‐seven children (age, 2 months to 19·9 years) of 51 eligible patients were followed for 1 year. Clinical and baseline endocrine variables were assessed in all 3 and 12 months after TBI ; children ≥ 6 years underwent two stimulation tests (glucagon stimulation and megatest). Results In the group ≥6 years, 11 of 23 patients (47·8%) had a subnormal GH peak 3 months after TBI that persisted in 8 of 23 patients (34%) after 1 year. The GH response showed no correlation with injury severity ( GCS , Marshall classification). Growth velocity was normal in all patients, except for one. Body mass index ( BMI ) SDS increased significantly in the group with low GH response. A suboptimal cortisol was observed in 10 of 23 subjects, which normalized in all but three, 1 year thereafter. All patients but one showed a pubertal response to Gn RH testing. No clinical or hormonal abnormalities were detectable in children <6 years. Conclusion Our results recommend to prospectively follow children after TBI : firstly, because the impairment of pituitary function cannot be predicted, and secondly, to avoid the potential consequences of pituitary dysfunction. Prospective clinical trials are needed before recommending a systematic screening after TBI and/or GH therapy either in postpubertal children or in prepubertal children who grow normally.