Growth Hormone Deficiency Following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services
Open accessAbstract
Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. This review focuses on GH deficiency (GHD), the most common post-TBI pituitary hormone deficiency. GHD is associated with abnormal body composition, lipid metabolism, bone mineral density, executive brain functions, behavior, and height outcomes in pediatric, adolescent, and transition-age patients. Despite its relatively frequent occurrence, post-TBI GHD has not been well studied in these patients; hence, diagnostic and treatment recommendations are limited. Here, we examine the occurrence and diagnosis of TBI, retrospectively analyze post-TBI hypopituitarism and GHD prevalence rates in pediatric and adolescent patients, and discuss appropriate GHD testing strategies and GH dosage recommendations for these patients. We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.
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Studies indicate that the majority of children diagnosed with TBI-related GHD show onset of symptoms between 6 months and 2 years post-injury, with some cases taking longer.
“Studies indicate that the majority of children diagnosed with TBI-related GHD show onset of symptoms between 6 months and 2 years post-injury, with some cases taking longer to manifest [24,25,26,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [24]
The TBI events section says GH deficiencies may appear in the acute phase and that testing is often deferred until 3–6 months after injury. The assessment and treatment section says pituitary deficiencies can develop later and new symptoms may arise during the transition phase. Neither section establishes that a majority of children with TBI-related GHD develop symptoms between 6 months and 2 years post-injury; pages are not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredResearch suggests that persistence of GHD beyond two years is more common in cases of significant hypothalamic or pituitary trauma.
“Research suggests that the persistence of GHD beyond two years is more common in cases of significant hypothalamic or pituitary trauma [24,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [24]
The Introduction (page unavailable) links post-traumatic pituitary dysfunction to direct hypothalamic or pituitary injury, and “Post-TBI hypopituitarism in children and adolescents” says severe TBI appears to carry the highest risk of pituitary hormone deficiency. The paper discusses GHD in the chronic phase, but the passages found do not establish that GHD persisting beyond two years is more common specifically after significant hypothalamic or pituitary trauma. (LLM, conf=0.78)
Experimental — accuracy not yet measuredLongitudinal follow-up studies indicate that GH secretion may normalize within 1 to 2 years after injury in some children, especially when the initial injury was less severe and no major structural damage to the HPA occurred.
“Longitudinal follow-up studies have indicated that GH secretion may normalize within 1 to 2 years after the injury in some children, especially when the initial injury was less severe and no major structural damage to the HPA occurred [24,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [24]
In Methods, “TBI events in children and adolescents” (page unavailable), the review says pituitary deficits identified within the first year after TBI may be transient and recover. “Testing for GHD in pediatric and adolescent patients” also says GHD can be transient. Neither passage supports the specific 1–2-year normalization window or the claim that recovery is especially likely after less severe injury without major structural damage to the hypothalamic–pituitary axis. (LLM, conf=0.86)
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References 125 · Cited by 19
Research works printed but not linked: 1
- [36]National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on the Review of the Department of Veterans Affairs Examinations for Traumatic Brain Injury. Evaluation of the disability determination process for traumatic brain injury in veterans. National Academies Press (U.S.): Washington, DC; 2019. 31211534
- Authors
- Wexler, T. L., Reifschneider, K., Backeljauw, P., Cárdenas, J. F., Hoffman, A. R., Miller, B. S., & Yuen, K. C. J.
- Affiliations
- NYU Langone Health (US)
- Eastern Virginia Medical School (US)
- Cincinnati Children's Hospital Medical Center (US)
- Barrow Neurological Institute (US)
- Stanford Medicine (US)
- University of Minnesota (US)
- Corresponding author
- Wexler, Tamara L.
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2023-06-27
- Volume
- 40
- Issue
- 13-14
- Pages
- 1274-1285
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- PMC
- PMC10294565
- OpenAlex
- W4321748250
- Cited by
- 19
- References
- 125
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 2
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neurotrauma (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- growth hormone deficiency, traumatic brain injury, pediatric patients, adolescents, transition to adult care, hypopituitarism, anterior pituitary insufficiency, body composition, bone mineral density, executive function, endocrine disorders
- MeSH terms
- Chronic Traumatic Encephalopathy, Brain Injuries, Traumatic, Adolescent, Adult, Child, Humans, Hypopituitarism, Quality of Life, Retrospective Studies, Growth Hormone, Human Growth Hormone
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