Endocrine dysfunction following traumatic brain injury in children
Abstract
Objective To identify the incidence of endocrine dysfunction in children following traumatic brain injury (TBI). Study design This was a prospective evaluation of 31 children after TBI. Inclusion criteria included Glasgow Coma Scale score ≤ 12 and age 1.5-18 years. We evaluated thyroid function, insulin-like growth factor I, insulin-like growth factor-binding protein 3, and cortisol at 1, 3, 6, and 12 months after injury, and assessed prolactin at 3 and 6 months. At 6 months, we also assessed overnight spontaneous growth hormone secretion, nocturnal thyrotropin surge, adrenal reserve, and serum and urine osmolarity. Results The average patient age was 11.6 years, and mean Glascow Coma Scale score was 6. The incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months. At 12 months after injury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency. Endocrine dysfunction at 1 year did not correlate with the severity of injury. Conclusions Endocrine dysfunction after TBI is common in children, but most cases resolve by 1 year. We recommend endocrine surveillance at both 6 and 12 months following moderate or severe TBI to ensure early intervention for persistent or late-occurring endocrine sequelae.
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Loss of menstrual regularity was common in the first six months after injury in 22% of adolescent females, but all resolved by one year.
“Loss of menstrual regularity was common in the first six months after injury in 22% of adolescent females, but all resolved by one year.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
One case of secondary adrenal insufficiency at six months resolved by 12 months.
“One case of secondary adrenal insufficiency at six months resolved by 12 months.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Of 13% with GHD at six months, all but one resolved by 12 months.
“Of 13% with GHD at six months, all but one resolved by 12 months.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Three children had water imbalance/diabetes insipidus, but all were transient and resolved by six months.
“Three children had water imbalance/diabetes insipidus, but all were transient and resolved by six months.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Of thyroid abnormalities in 13 children, all but two resolved by 12 months.
“Of thyroid abnormalities in the 13 children, all but two resolved by 12 months.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Eight children (33%) had elevated prolactin, but all had resolved by 12 months.
“Eight children (33%) had elevated prolactin, but all had resolved by 12 months.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
No risk factors such as GCS or radiographic findings were identified that could indicate which children would have endocrine abnormalities.
“No risk factors such as GCS or radiographic findings were identified that could indicate which children would have endocrine abnormalities.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
To date, only four prospective studies in the pediatric age group have been published regarding endocrine abnormalities after TBI.
“To date, only four prospective studies in the pediatric age group have been published regarding endocrine abnormalities after TBI [34,47,48,49].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Kaulfers found no cases of low basal cortisol levels before six months after injury using strict criteria (cortisol <5 mcg/dL).
“Kaulfers [47] found no cases of low basal cortisol levels before six months after injury, using relatively strict criteria for diagnosis (cortisol <5 mcg/dL).”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Basal cortisol concentrations did not correlate well with peak cortisol response to low-dose ACTH stimulation at the six month visit.
“Basal cortisol concentrations did not correlate well with the peak cortisol response to low-dose ACTH stimulation test at the six month visit.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Kaulfers found 21% had low Free T4 at baseline and 24% at three months after TBI.
“Kaulfers found that 21% had a low Free T4 (FT4) at baseline and 24% at three months after TBI [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Patients with persistent endocrinopathies at one year reported a higher incidence of weight gain, mood disturbances and altered appetite than those without hormone deficiencies.
“Patients with persistent endocrinopathies at one year reported a higher incidence of weight gain, mood disturbances and altered appetite than those without hormone deficiencies [47,59].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Prevalence of endocrinopathies at 12 months has not been shown to correlate with severity of injury as measured by the Glasgow Coma Score.
“Prevalence of endocrinopathies at 12 months has not been shown to correlate with severity of injury as measured by the Glasgow Coma Score [24,47,49].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Of 31 children prospectively evaluated after severe TBI, 10% had transient DI but all cases resolved.
“Of 31 children prospectively evaluated after severe TBI, 10% had transient DI but all cases resolved [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Radiographic findings on CNS imaging did not reliably predict presence or absence of endocrinopathies at 12 months after TBI.
“Radiographic findings on CNS imaging did not reliably predict presence or absence of endocrinopathies at 12 months after TBI [24,47,49].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
In the absence of endocrine and growth surveillance, years may pass before a correct diagnosis is made and endocrine treatment started, leaving a significant impact on quality of life.
“In the absence of endocrine and growth surveillance, years may pass before a correct diagnosis is made and endocrine treatment started, leaving a significant impact on quality of life [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Kaulfers et al. found that hypogonadism following TBI in pediatric patients is generally transient, with one male recovering by three months and female patients with secondary amenorrhea resolving within one year.
“Similarly, Kaulfers et al. found that hypogonadism following TBI in pediatric patients is generally transient. In their study, one male patient developed clinical signs of hypogonadism within the first month post-injury but showed complete recovery by three months. Female patients who experienced secondary amenorrhea also demonstrated resolution within one year.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [40]
A new case of hypogonadism was diagnosed at the one-year mark after pediatric TBI, highlighting the need for ongoing endocrine surveillance for at least 12 months after TBI.
“Notably, a new case of hypogonadism was diagnosed at the one-year mark, highlighting the need for ongoing endocrine surveillance for at least 12 months after TBI [40].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [40]
Four of six prepubertal age children developed precocious puberty, while 14% of the pubertal adolescents showed rapid pubertal progression.
“Four of six prepubertal age children developed precocious puberty, while 14% of the pubertal adolescents showed rapid pubertal progression.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Kaulfers prospectively evaluated 31 children and adolescents; incidence of any endocrinopathy in moderate to severe head injury was 15% at one month, 75% at six months, and 29% at 12 months after TBI.
“Kaulfers [47] prospectively evaluated 31 children and adolescents for endocrine function after TBI. The incidence of any endocrinopathy in children who had moderate to severe head injury was 15% at one month after injury, 75% at six months, and 29% at 12 months after TBI.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Many endocrine abnormalities found in the first few months after pediatric TBI resolved by one year.
“Interestingly, many of the endocrine abnormalities found in the first few months after injury resolved by one year.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
One patient clinically presented with hypogonadism within one month of injury, and by three months he had recovered.
“One patient clinically presented with hypogonadism within one month of injury, and by three months he had recovered.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Observations by Kaulfers suggested that hypogonadism is usually transient.
“Observations by Kaulfers [47] also suggested that hypogonadism is usually transient.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Female patients had secondary amenorrhea which resolved by one year after injury.
“Female patients has secondary amenorrhea which resolved by one year after injury.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Overall, four children (16%) had a rapid tempo of puberty by six months after injury, and all of them continued to progress in puberty at the 12 month visit.
“Overall, four children (16%) had a rapid tempo of puberty by six months after injury, and all of them continued to progress in puberty at the 12 month visit.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Two of them required GnRH agonist therapy to slow down the progression of puberty.
“Two of them required GnRH agonist therapy to slow down the progression of puberty [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
Prospectively, Kaulfers found a high incidence of rapid and/or precocious puberty in children after TBI.
“Prospectively, Kaulfers [47] found a high incidence of rapid and/or precocious puberty in children after TBI.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
One new case of GnRH deficiency was evident at one year, highlighting the need for these children to be closely monitored for at least one year after injury.
“One new case of GnRH deficiency was evident at one year, highlighting the need for these children to be closely monitored for at least one year after injury [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
In a prospective study, PRL elevation was one of the most common abnormalities observed at both three and six months after injury, even after eliminating patients on medications that cause hyperprolactinemia; all cases resolved by 12 months.
“In prospective study, PRL elevation was one of the most common abnormalities observed at both three and six months after injury, even after eliminating those patients on medications that cause hyperprolactinemia [47]. However, all cases resolved by 12 months after injury.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
An abnormal TSH surge was identified in 46% of patients at six months after TBI, and 72% of them had Free T4 in the lowest third of the normal range; TSH surge continued abnormal in 10% at 12 months.
“An abnormal TSH surge was identified in 46% of patients at six months after TBI, and most (72%) of them had a Free T4 in the lowest third of the normal range. The TSH surge continued to be abnormal in 10% of the patients at 12 months [47].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [47]
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- Authors
- Kaulfers, A.-M. D., Backeljauw, P. F., Reifschneider, K., Blum, S., Michaud, L., Weiss, M., & Rose, S. R.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Children's Hospital of The King's Daughters (US)
- Corresponding author
- Rose, Susan R.
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 157
- Issue
- 6
- Pages
- 894-899
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2014868305
- Semantic Scholar
- 6354602e27e5442b148669d9d2ad50cb2f68b689
- Cited by
- 84
- References
- 31
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 9 · 2018: 3 · 2017: 5 · 2016: 7 · 2015: 8 · 2014: 7 · 2013: 8 · 2012: 4
- FWCI
- 2.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources
- U.S. Public Health Service (UL1 RR026314)
- National Institutes of Health (M01 RR08084)
- 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 › Growth Hormone and Insulin-like Growth Factors
- Keywords
- traumatic brain injury, pediatric brain injury, endocrine dysfunction, precocious puberty, hypothyroidism, growth hormone deficiency, insulin-like growth factor I, insulin-like growth factor binding protein-3, prolactin, cortisol, thyroid function, endocrine surveillance, injury severity
- MeSH terms
- Adolescent, Brain Injuries, Child, Child, Preschool, Endocrine System Diseases, Female, Humans, Male, Prospective Studies, Incidence, Disease Progression
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