The hypothalamus and pituitary are essential for childhood and adolescent development and are vulnerable to injury and dysfunction following brain trauma. Hypothalamic-pituitary dysfunction has been well recognized after traumatic brain injury (TBI) in adults. However, data regarding hypothalamic-pituitary function in brain-injured children and adolescents are scant. It is necessary for physicians as well as patients and family members to know that onset of hypothalamic-pituitary deficits can occur even after several years following brain injury.
Acerini et al reviewed the available pediatric data, which showed that after both mild and severe TBI, hypopituitarism may occur; growth hormone (GH) and gonadotropin deficiencies appear to be most common. Precocious puberty has also been documented. Detailed investigations of pituitary function have been reported in 20 patients (12 males, 7 females, and 1 unspecified sex). Subjects ranged in age from infancy to 16 years at the time of injury; they were investigated between 1 and 42 years after the initial episodes of TBI. All patients had multiple anterior pituitary hormone deficiencies, except one, who had isolated GH deficiency. The frequencies of deficient hormones were: GH 85%, LH/FSH 80%, TSH 75%, and ACTH 50%. It was notable that in 6 patients, multiple deficiencies were documented after relatively mild head injury without loss of consciousness. Pituitary stalk transaction was demonstrated on MRI in several cases. The diagnosis of hypothalamic-pituitary deficiency was made during childhood and adolescence in 17 of the 20 patients and during adult life in the remaining 3. The key presenting symptoms were growth failure, delayed or arrested puberty, secondary amenorrhea or reduced libido. Delay in the diagnosis was extreme in many cases and hypopituitarism was clearly not considered as a possible complication of the TBI until defects of growth or reproductive function became obvious.
Acerini and colleagues urged pediatric endocrinologists, in collaboration with adult endocrinologists, to perform formal prospective research studies in patients suffering from TBI to clarify prevalence, natural history, and response to hormone replacement.
Reference
Nishi, Y. and Lifshitz, F. (2007) Childhood Hypopituitarism after traumatic brain injury [review and comment from the literature]. Growth, Genetics and Hormones 23(2): 24-35.
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