Is routine endocrine evaluation necessary after paediatric traumatic brain injury?
Abstract
Background Traumatic brain injury (TBI) is a common event in childhood. It is a recognised cause of hypopituitarism both in adult and paediatric patients. Routine endocrine evaluation has been proposed for adult TBI-survivors; nevertheless, incongruous data have been reported in children.Aim The goal of this study was to describe the prevalence of pituitary dysfunction after TBI in a cohort of children.Material/subjects and methods This is a cross-sectional study comprising retrospective medical record review and prospective testing. Children with brain injury discharged from the Paediatric Intensive Care Unit from year 2004 to 2009 were recruited. Height and weight were recorded, systemic examination was performed and baseline pituitary function tests were undertaken. Provocative tests were performed only if abnormal basal levels were detected.Results Thirty-six patients were collected; the mean age at assessment was 7.2 years and the mean interval since injury 3.3 years. All patients had skull fracture or intracranial haemorrhage; 36.6 % of them had moderate to severe TBI. No abnormalities were found on examination. Low serum IGF 1 levels were detected in four patients and two patients had low serum cortisol levels with inappropriately normal plasma ACTH concentrations. No evidence of pituitary dysfunction was observed in these patients after clinical follow-up, repeated baseline hormone levels or dynamic function tests.Conclusions No endocrine sequelae have been detected in this population. The routine endocrine evaluation in children with mild to moderate TBI might not be justified, according to our findings.
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Cross-sectional studies documented 16%-61% prevalence of hypopituitarism at 1-5 years after injury in children.
“Cross-sectional studies documented 16%–61% prevalence of hypopituitarism at 1–5 years after injury [23,34,37,38,39,40,41,42,43].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [43]
Other studies have reported a lower prevalence of TSH deficiency, ranging from 5 to 12%.
“In contrast, other studies have reported a lower prevalence of TSH deficiency, ranging from 5 to 12% [20,30].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [30]
Salomon-Estebanez et al. observed that in some cases, IGF-1 levels and growth velocity spontaneously normalized within one year following TBI without stimulation testing.
“Salomon-Estebanez et al. observed that in some cases, IGF-1 levels and growth velocity spontaneously normalized within one year following TBI. Notably, no stimulation testing was necessary, and children showed normal growth throughout the follow-up period, suggesting that milder cases of GHD may resolve without intervention [30].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [30]
On retest all four subjects demonstrated spontaneous increase in IGF-I levels and normal growth velocity, therefore no subjects underwent stimulation testing.
“On retest all four subjects demonstrated spontaneous increase in IGF-I levels and normal growth velocity, therefore no subjects underwent stimulation testing [43].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [43]
Salomon-Estebanez suggested that IGF-I values and growth velocity were poor screening tools for detection of TBI-induced GHD.
“Salomon-Estebanez [43] also suggested that IGF-I values and growth velocity were poor screening tools for detection of TBI-induced GHD.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [43]
Endocrine screening of 36 patients (mean age 7.2 years, mean duration since TBI 3.3 years) identified six who required further investigation: four with low IGF-1 levels and two with low cortisol; subsequent insulin tolerance testing revealed normalization of ACTH-cortisol axis.
“Endocrine screening of 36 patients (mean age 7.2 years, mean duration since TBI 3.3 years) identified six who required further investigation: four with low IGF-1 levels and two with low cortisol. Subsequent insulin tolerance testing revealed normalization of ACTH-cortisol axis [43].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [43]
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References 33 · Cited by 15
- Authors
- Salomón-Estébanez, M. A., Grau, G., Vela, A., Rodríguez, A., Morteruel, E., Castaño, L., & Rica, I.
- Affiliations
- Hospital de Cruces (ES)
- Centre for Biomedical Network Research on Rare Diseases (ES)
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (ES)
- Corresponding author
- Rica, I.
- Venue
- Journal of Endocrinological Investigation
- Published
- 2014-01-09
- Volume
- 37
- Issue
- 2
- Pages
- 143-148
- ISSN
- 0391-4097 (ISSN-L)
- 1720-8386
- OpenAlex
- W2319435874
- Cited by
- 15
- References
- 33
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2020: 2 · 2019: 2 · 2018: 1 · 2016: 3 · 2015: 1
- FWCI
- 0.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Endocrinological Investigation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- pediatric traumatic brain injury, hypopituitarism, pituitary dysfunction, endocrine evaluation, insulin-like growth factor I, cortisol, ACTH, skull fracture, intracranial hemorrhage, long-term follow-up
- MeSH terms
- Adolescent, Brain Injuries, Child, Child, Preschool, Cross-Sectional Studies, Diagnostic Techniques, Endocrine, Diagnostic Tests, Routine, Female, Humans, Hypopituitarism, Infant, Male, Predictive Value of Tests, Retrospective Studies, Intensive Care Units, Pediatric
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