Pituitary dysfunction after traumatic brain injury: Are there definitive data in children?
Abstract
In the past decade, several studies in adults and children have described the risk of pituitary dysfunction after traumatic brain injury (TBI). As a result, an international consensus statement recommended follow-up on the survivors. This paper reviews published studies regarding hypopituitarism after TBI in children and compares their results. The prevalence of hypopituitarism ranges from 5% to 57%. Growth hormone (GH) and ACTH deficiency are the most common, followed by gonadotropins and thyroid-stimulating hormone. Paediatric studies have failed to identify risk factors for developing hypopituitarism, and therefore we have no tools to restrict screening in severe TBI. In addition, the present review highlights the lack of a unified follow-up and the fact that unrecognised pituitary dysfunction is frequent in paediatric population. The effect of hormonal replacement in patient recovery is important enough to consider baseline screening and reassessment between 6 and 12 months after TBI. Medical community should be aware of the risk of pituitary dysfunction in these patients, given the high prevalence of endocrine dysfunction already reported in the studies. Longer prospective studies are needed to uncover the natural course of pituitary dysfunction, and new studies should be designed to test the benefit of hormonal replacement in metabolic, cognitive and functional outcome in these patients.
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In pediatric cohorts, the prevalence of post-traumatic pituitary dysfunction has been reported to range from 5% to 57%, with estimates increasing to 86% in studies that considered hyperprolactinemia as an abnormality.
“In pediatric cohorts, the prevalence of post-traumatic pituitary dysfunction has been reported to range from 5% to 57%, with estimates increasing to 86% in studies that considered ‘hyperprolactinemia’ as an abnormality [16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Children who sustain TBI are more frequently affected by delayed or arrested puberty, commonly due to hypogonadotropic hypogonadism.
“Children who sustain TBI are more frequently affected by delayed or arrested puberty, commonly due to hypogonadotropic hypogonadism [6,16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
There is currently non-conclusive evidence linking Glasgow Coma Scale scores or radiological findings with the risk of developing pituitary dysfunction following TBI.
“However, there is currently non-conclusive evidence linking Glasgow Coma Scale (GCS) scores or radiological findings with the risk of developing pituitary dysfunction following TBI [2,5,16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Heather et al. reported approximately 1-2 cases of CPP per pediatric cohort; among girls, incidence was comparable to the general population (approximately 20 per 10,000), whereas in boys, a slight increase was observed (approximately 4 per 10,000).
“Heather et al. reported approximately 1–2 cases per pediatric cohort. Among girls, the incidence was comparable to that of the general population (approximately 20 per 10,000), whereas in boys, a slight increase in incidence was observed (approximately 4 per 10,000) [16,31].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Casano-Sancho et al. found that 47% of children had low stimulated cortisol levels at three months post-TBI using the glucagon test, but all but three normalized by 12 months.
“Casano-Sancho et al. found that 47% of children had low stimulated cortisol levels at three months post-TBI using the glucagon test, but all but three normalized by 12 months [16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Similar transient alterations in thyroid function were also described by Casano-Sancho and Kaulfers.
“Similar transient alterations in thyroid function were also described by Casano-Sancho and Kaulfers [16,44].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Reported prevalence of post-TBI pituitary dysfunction in children ranges from 5% to 57%.
“Reported prevalence of post-TBI pituitary dysfunction in children ranges from 5 to 57%, reflecting a deep heterogeneity in injury severity, diagnostic methods, and timing of evaluations.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Hypogonadism prevalence appears lower in pediatric populations, typically transient, reported in approximately 4-9% of cases, compared to prevalence rates of up to 29% in adult cohorts.
“However, its prevalence appears to be lower in pediatric populations, where hypogonadism—typically transient—has been reported in approximately 4–9% of cases, compared to prevalence rates of up to 29% in adult cohorts [16,38,39].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
These nonspecific features of adrenal insufficiency are frequently misattributed to functional or psychological causes, often delaying appropriate endocrine evaluation until adrenal crisis reveals the underlying deficiency.
“These nonspecific features are frequently misattributed to functional or psychological causes, often delaying an appropriate endocrine evaluation until adrenal crisis reveals the underlying deficiency [5,16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
Permanent DI is uncommon, although transient forms have been reported in approximately 4% of affected children.
“Permanent DI is uncommon, although transient forms have been reported in approximately 4% of affected children [16].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [16]
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Dassa, Y., Crosnier, H., Chevignard, M., Viaud, M., Personnier, C., Flechtner, I., Meyer, P., Puget, S., Boddaert, N., Breton, S., et al. (2019) · European Journal of Endocrinology · doi:10.1530/eje-19-0034 · Cited by 34 · see citing works
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Cammisa, I., Malavolta, E., Sodero, G., Rigante, D., & Cipolla, C. (2025) · Children · doi:10.3390/children12111484 · Cited by 1 · see citing works
“Similar transient alterations in thyroid function were also described by Casano-Sancho and Kaulfers [16,44].”
Influential
- Authors
- Casano-Sancho, P.
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2016-11-21
- Volume
- 102
- Issue
- 6
- Pages
- 572-577
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2551995636
- Semantic Scholar
- 7fe27c101519c924f8d3c226da02688d164b0378
- Cited by
- 30
- References
- 37
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 1 · 2020: 6 · 2019: 6
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- 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
- pituitary dysfunction, traumatic brain injury, pediatric patients, hypopituitarism, growth hormone deficiency, ACTH deficiency, gonadotropin deficiency, thyroid-stimulating hormone deficiency, endocrine screening, hormone replacement therapy, risk factors, follow-up
- MeSH terms
- Brain Injuries, Child, Humans, Hypopituitarism, Research Design, Risk Factors, Prevalence
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