Pituitary function in paediatric survivors of severe traumatic brain injury
Abstract
BACKGROUND: Traumatic brain injury (TBI)-mediated hypopituitarism is an increasingly recognised problem. Paediatric survivors of TBI may be vulnerable to the possible effects of pituitary deficits as pituitary hormones control normal growth and development. Research concerning pituitary dysfunction following childhood TBI is limited. AIM: To identify pituitary dysfunction in paediatric survivors of severe TBI. METHODS: Of 1020 children who sustained a TBI and were admitted to the Royal Children's Hospital, Melbourne, Australia over 10 years, 117 were identified as survivors of severe TBI. 54 patients (31 males) were enrolled and administered questionnaires regarding quality of life and possible endocrine dysfunction. Where indicated, hormone testing was performed. RESULTS: 29 of the 54 patients underwent hormonal investigations, while 21 who had satisfactory questionnaires did not (four patients had already been diagnosed with pituitary deficiencies). In those 29 patients, TBI occurred at ages ranging from 0.25 to 16.80 years (median 9.7 years). Time from TBI to study ranged from 0.9 to 8.5 years (median 4.5 years). Of the 54 patients, nine had pituitary dysfunction, of whom four had multiple pituitary hormone deficiencies. CONCLUSIONS: Our study that confirms that paediatric survivors of severe TBI may develop pituitary dysfunction. Pituitary function should therefore be determined in these patients.
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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 [38]
Poomthavorn et al. reported a 4% incidence of hypogonadism within the first year following TBI, with presentations classified as either transient or permanent.
“Poomthavorn et al. reported a 4% incidence of hypogonadism within the first year following TBI, with presentations classified as either transient or permanent [20].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [20]
Poomthavorn et al. reported that only one out of 15 tested children had a low basal cortisol level, and this patient responded normally to ACTH stimulation.
“Poomthavorn et al. reported comparable findings: only one out of 15 tested children had a low basal cortisol level, and this patient responded normally to ACTH stimulation [20].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [20]
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 [20]
Poomthavorn et al. identified pituitary dysfunction in 17% of pediatric TBI patients.
“Similarly, Poomthavorn et al. identified pituitary dysfunction in 17% of patients, whereas Norwood et al. reported isolated growth hormone deficiency (GHD) in 16% [2,20].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [20]
Norwood et al. reported isolated growth hormone deficiency in 16% of pediatric TBI patients.
“whereas Norwood et al. reported isolated growth hormone deficiency (GHD) in 16% [2,20].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [20]
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 [20]
Norwood et al. reported that using arginine/glucagon testing, 5 of 32 subjects (16%) failed to achieve an overnight GH peak above 5 ng/mL, while 10 of 32 (22%) had a stimulated peak GH response below 7 ng/mL.
“For example, Norwood et al. reported that, using arginine/glucagon testing, 5 of 32 subjects (16%) failed to achieve an overnight GH peak above 5 ng/mL, while 10 of 32 (22%) had a stimulated peak GH response below 7 ng/mL.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [20]
Among retrospective pediatric studies, Poomthavorn found that 4% of children had hypogonadism within the first year of injury, either transient or permanent, with no new cases of hypogonadism found at more than eight months after injury.
“Among retrospective pediatric studies, Poomthavorn [38] found that 4% of children had hypogonadism within the first year of injury, either transient or permanent, with no new cases of hypogonadism found at more than eight months after injury.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [38]
In a retrospective study of 54 patients, only one of 15 tested had a low basal cortisol level, but that patient had a normal stimulated cortisol level on a low-dose ACTH stimulation test.
“Poomthavorn [38] demonstrated similar results in retrospective study of 54 patients. Only one of 15 patients tested had a low basal cortisol level, but that patient had a normal stimulated cortisol level on a low-dose ACTH stimulation test [38].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [38]
Among retrospective pediatric studies, Poomthavorn identified one child (2%) with precocious puberty four years after TBI.
“Among retrospective pediatric studies, Poomthavorn [38] identified one child (2%) with PP four years after TBI, and Einaudi [34] found one child (5%) with PP five years after injury.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [38]
Two retrospective studies in children each reported one child with elevated PRL one to two years after injury; both had PRL elevation associated with other pituitary deficiencies including transient hypogonadism.
“Two retrospective studies in children each reported one child with elevated PRL one to two years after injury [37,38]. Both children had PRL elevation associated with other pituitary deficiencies including transient hypogonadism.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [38]
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Efectos del traumatismo craneoencefálico sobre la función hipofisaria
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Failure to Thrive in a 15-month-old with a History of Head Trauma
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The Case of Hypopituitarism in Traumatic Brain Injury
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Endocrinopathy and Dysautonomia
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- Authors
- Poomthavorn, P., Maixner, W., & Zacharin, M.
- Affiliations
- Royal Children's Hospital (AU)
- Corresponding author
- Zacharin, M
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2007-11-06
- Volume
- 93
- Issue
- 2
- Pages
- 133-137
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W1970558511
- Semantic Scholar
- dff81dc54ce0ca2ac7669f33663bc9785cc38d70
- Cited by
- 63
- References
- 32
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 10
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- traumatic brain injury, pediatric patients, pituitary dysfunction, hypopituitarism, multiple pituitary hormone deficiency, endocrine dysfunction, quality of life, growth and development
- MeSH terms
- Adolescent, Adult, Body Height, Body Weight, Brain Injuries, Child, Child, Preschool, Female, Growth Disorders, Hormones, Humans, Hypopituitarism, Male, Pituitary Gland, Pituitary Hormones, Patient Selection
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