Pituitary dysfunction after traumatic brain injury in children: Is there a need for ongoing endocrine assessment?
Abstract
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 GnRH 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.
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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 [48]
Only one of 16 peripubertal children followed for one year after TBI failed to respond to GnRH testing.
“Only one of 16 peripubertal children followed for one year after TBI failed to respond to GnRH testing [48].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
The lack of standardized diagnostic criteria and follow-up protocols has significantly contributed to the heterogeneity of findings on GHD after pediatric TBI.
“The lack of standardized diagnostic criteria and follow-up protocols has significantly contributed to the heterogeneity of findings [6,29].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [29]
In children, TBI severity has not shown any correlation with hormone deficiency rates.
“In children, TBI severity has not shown any correlation with hormone deficiency rates [30-32].”
From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [30]
Casano-Sancho's study found that 11 out of 23 children aged 6 years or older exhibited subnormal GH peaks three months following TBI, with 34% of these cases persisting at one year.
“Casano-Sancho’s study found that 11 out of 23 children aged 6 years or older exhibited subnormal GH peaks three months following TBI, with 34% of these cases persisting at one year [29].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [29]
Poomthavorn et al. included follow-up periods ranging from 1.7 to 9.6 years and found that 72% of children demonstrated normal growth velocity or achieved an appropriate final height within their expected target height range.
“However, some studies, such as those by Poomthavorn et al., included follow-up periods ranging from 1.7 to 9.6 years and found that 72% of children demonstrated normal growth velocity or achieved an appropriate final height within their expected target height range [20,29].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [29]
Another factor contributing to inconsistent findings is the lack of adequate long-term follow-up in many studies, which is essential for detecting delayed or evolving hormonal deficiencies.
“Another factor contributing to inconsistent findings is the lack of adequate long-term follow-up in many studies, which is essential for detecting delayed or evolving hormonal deficiencies [6,29,32].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [29]
Casano-Sancho prospectively followed 37 children for one year; those older than six years underwent endocrine evaluation at three and 12 months after TBI.
“Casano-Sancho [48] prospectively followed 37 children for one year (60% severe TBI, 23 greater than six years old). Those older than six years underwent endocrine evaluation at three and 12 months after TBI.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Growth velocity was normal in all patients except one, but all demonstrated significant increase in body mass index.
“Interestingly, growth velocity was normal in all patients except for one, but all demonstrated significant increase in body mass index.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Ten of 23 had suboptimal cortisol response (7-16 mcg/dL) to glucagon initially, which normalized over time in seven of 10.
“Similarly, 10 of 23 had suboptimal cortisol response (7–16 mcg/dL) to glucagon initially, which normalized over time in seven of 10.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Transiently abnormal thyroid function was noted in three patients, while no sustained pubertal abnormalities were observed.
“Transiently abnormal thyroid function was noted in three patients, while no sustained pubertal abnormalities were observed.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Of 23 children older than six years, 11 (48%) had subnormal GH peak at three months that persisted in eight (34%) after one year.
“Of them, 11 of 23 (48%) had subnormal GH peak at three months that persisted in eight of 23 (34%) after one year.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
The prospective study by Casano-Sancho noted that 11 of 23 patients ≥6 y old had a subnormal GH peak response to glucagon and clonidine three months after TBI that persisted in eight of 23 (34%) after 1 year.
“The prospective study by Casano-Sancho [48] noted that 11 of 23 patients ≥6 y old had a subnormal GH peak response to glucagon and clonidine three months after TBI that persisted in eight of 23 (34%) after 1 year.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Growth velocity was normal and IGF-I levels were normal in all patients except one; however, BMI increased significantly in those with confirmed GHD.
“Growth velocity was normal and IGF-I levels were normal in all patients except one; however, BMI increased significantly in those with confirmed GHD [48].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
10 of 23 children over six years old demonstrated suboptimal cortisol response to glucagon at three months after TBI, with all but three normalizing by 12 months after TBI.
“Likewise, 10 of 23 children over six years old demonstrated suboptimal cortisol response to glucagon at three months after TBI, with all but three normalizing by 12 months after TBI [48].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
Three of 37 children followed prospectively after TBI had elevated basal TSH with FT4 within the normal range; all values normalized at 12 months after injury.
“Similarly, three of 37 children followed prospectively after TBI had elevated basal TSH with FT4 within the normal range; all these values normalized at 12 months after injury [48].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [48]
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- Authors
- Casano‐Sancho, P., Suárez, L., Ibáñez, L., García‐Fructuoso, G., Medina, J., & Febrer, A.
- Affiliations
- Pediatric Endocrinology Unit Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Hospital Sant Joan de Déu Barcelona (ES)
- ORCID
- Ibáñez, Lourdes
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2013-06-27
- Volume
- 79
- Issue
- 6
- Pages
- 853-858
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2104383544
- Cited by
- 36
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 6 · 2022: 2 · 2021: 1 · 2020: 5 · 2019: 6 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 1 · 2013: 2
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, pediatric patients, hypopituitarism, growth hormone deficiency, glucagon stimulation test, cortisol, pubertal development, GnRH stimulation, body mass index, endocrine screening, long-term follow-up
- MeSH terms
- Adolescent, Brain Injuries, Child, Child, Preschool, Female, Humans, Hydrocortisone, Hypopituitarism, Infant, Gonadotropin-Releasing Hormone, Longitudinal Studies, Male, Pituitary Function Tests, Pituitary Hormones, Prospective Studies, Human Growth Hormone, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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