Traumatic brain injury in children and adolescents: Surveillance for pituitary dysfunction
Open accessAbstract
BACKGROUND: Children who sustain traumatic brain injury (TBI) are at risk for developing hypopituitarism, of which growth hormone deficiency (GHD) is the most common manifestation. OBJECTIVE: To determine the prevalence of GHD and associated features following TBI among children and adolescents. STUDY DESIGN: A total of 32 children and adolescents were recruited from a pediatric TBI clinic. Participants were diagnosed with GHD based on insufficient growth hormone release during both spontaneous overnight testing and following arginine/glucagon administration. RESULTS: GHD was diagnosed in 5/32 participants (16%). Those with GHD exhibited more rapid weight gain following injury than those without GHD and had lower levels of free thyroxine and follicle-stimulating hormone. Males with GHD had lower testosterone levels. CONCLUSIONS: GHD following TBI is common in children and adolescents, underscoring the importance of assessing for GHD, including evaluating height and weight velocities after TBI. Children and adolescents with GHD may further exhibit absence or intermediate function for other pituitary hormones.
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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 [39]
The Discussion (page unavailable) reports 42% growth hormone deficiency in a previous cross-sectional study of children after TBI, and the Results report 16% in Norwood's own cohort. The paper does not document a 16%–61% range for hypopituitarism in cross-sectional studies or establish the stated 1–5-year interval. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThere 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 [2]
The Discussion reports conflicting evidence on whether initial GCS predicts later pituitary deficiency and finds no GCS difference between children with and without growth hormone deficiency. The Methods mention abnormal MRI findings as an enrollment criterion, but the paper does not assess whether radiological findings predict pituitary dysfunction. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNorwood 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 [2]
The Results report GHD in 5 of 32 children and adolescents with TBI (16%). They do not establish that all five had isolated GHD: the Results also state that one subject with GHD had diabetes insipidus, and the Discussion notes abnormalities in other hormone axes. (LLM, conf=0.92)
Experimental — accuracy not yet measuredPoomthavorn 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 [2]
The Results (page unavailable) report GHD in 5 of 32 pediatric TBI patients (16%), supporting the finding attributed to Norwood, not the separate 17% finding attributed to Poomthavorn. The paper does not establish that all five cases were isolated GHD: the Results note that one patient with GHD also had diabetes insipidus. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNorwood 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 [2]
The Results (page not supplied) report 6/32 subjects below the overnight GH threshold, not 5/32; 5/32 (16%) failed both tests. They report 10/32 with an insufficient stimulated response, but that is 31%, not 22%, and the stimulated threshold was 7 ng/mL for subjects under 18 and 5 ng/mL for those 18 or older. (LLM, conf=0.94)
Experimental — accuracy not yet measured
Screening tests such as IGF-I and IGFBP3 can be helpful in excluding deficiency if the patient's results are above average for age (high sensitivity), but have poor specificity as adult data revealed that only 17%-30% of adult GHD subjects exhibited a low IGF-I level.
“Screening tests such as IGF–I and IGFBP3 can be helpful in excluding deficiency if the patient‘s results are above average for age (high sensitivity), but poor specificity as the adult data revealed that only 17%–30% of adult GHD subjects exhibited a low IGF-I level [39].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [39]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredNorwood studied 32 children using low overnight GH sampling surge and response to arginine/glucagon testing; five of 32 (16%) failed to have overnight GH peak above 5 ng/mL and 10 of 32 (22%) had a stimulated peak GH response less than 7 ng/mL; collectively, 34% exhibited insufficient GH secretion by one of the two tests.
“Norwood [39] studied 32 children recruited from the pediatric TBI clinic using both a low overnight GH sampling surge and response to arginine/glucagon testing (Table 1). Five of 32 subjects (16%) failed to have overnight GH peak above 5 ng/mL and 10 of 32 (22%) had a stimulated peak GH response less than 7 ng/mL. Collectively, 34% of subjects exhibited insufficient GH secretion by one of the two”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [39]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAlthough IGF-I levels tended to be lower in those with GHD, they were not significantly lower than in those subjects without GHD.
“Although IGF-I levels tended to be lower in those with GHD, they were not significantly lower than in those subjects without GHD [39].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [39]
Kaulfers found 11% had elevated TSH at baseline after injury.
“Interestingly, Kaulfers found that 11% had an elevated TSH at baseline after injury [39].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [39]
The Results (page unavailable) report no difference in TSH concentration between the study’s GHD and non-GHD groups, but give no baseline rate of elevated TSH. Searches for Kaulfers, elevated TSH, and 11% did not locate the attributed finding in our copy. (LLM, conf=0.73)
Experimental — accuracy not yet measuredHeather et al. observed a subnormal GH response of less than 10 mcg/L, with 16 subjects exhibiting a GH peak of less than 5 mcg/L following dual stimulation with clonidine and arginine.
“In contrast, Heather et al. observed a subnormal GH response of less than 10 mcg/L, with 16 subjects exhibiting a GH peak of less than 5 mcg/L following dual stimulation with clonidine and arginine [2,31].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [2]
The Methods describe this paper’s own arginine/glucagon stimulation test, and the Results report five of 32 subjects diagnosed with growth hormone deficiency. Neither section reports Heather et al.’s findings or the claimed 16 subjects tested with clonidine and arginine; searches for Heather and clonidine found no supporting passage. The different protocol in this paper does not establish what Heather et al. observed. (LLM, conf=0.74)
Experimental — accuracy not yet measured
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Gasco, V., Baldini, C., Guaraldi, F., Prencipe, N., Giacomo, S. D., Berton, A. M., Ghizzoni, L., Grottoli, S., & Ghigo, E. (2012) · L Endocrinologo · doi:10.1007/bf03345999
Miller, M. A. (2012) · Springer eBooks · doi:10.1007/978-3-642-02202-9_379
Endocrinopathy and Dysautonomia
Fote, G., Himstead, A. S., & Chen, J. W. (2025) · Neurosurgery Clinics of North America · doi:10.1016/j.nec.2025.03.008
Graça, G. M., Aguiar, L. R., & de Lacerda, L. (2026) · Growth Hormone & IGF Research · doi:10.1016/j.ghir.2026.101716
Haddock, M. L., Krishna, G., Yuen, K. C. J., & Thomas, T. C. (2026) · Growth Hormone & IGF Research · doi:10.1016/j.ghir.2026.101729
- Authors
- Norwood, K. W., DeBoer, M. D., Gurka, M. J., Kuperminc, M. N., Rogol, A. D., Blackman, J. A., Wamstad, J. B., Buck, M. L., & Patrick, P. D.
- Affiliations
- University of Virginia (US)
- Corresponding author
- Patrick, Peter D.
- Venue
- Clinical Pediatrics
- Publisher
- SAGE Publications
- Published
- 2010-08-19
- Volume
- 49
- Issue
- 11
- Pages
- 1044-1049
- ISSN
- 0009-9228 (ISSN-L)
- 1938-2707
- PMC
- PMC5596449
- OpenAlex
- W2125665709
- Cited by
- 46
- References
- 32
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 5 · 2018: 1 · 2016: 4 · 2015: 2 · 2014: 5 · 2013: 6 · 2012: 5
- FWCI
- 4.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Research Resources (M01RR000847, M01-RR 00847)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD060739-01, K08HD060739)
- 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 traumatic brain injury, adolescents, growth hormone deficiency, hypopituitarism, pituitary dysfunction, arginine stimulation test, growth hormone secretion, free thyroxine, follicle-stimulating hormone, testosterone, growth rate
- MeSH terms
- Adolescent, Arginine, Brain Injuries, Child, Female, Follicle Stimulating Hormone, Glucagon, Humans, Hypopituitarism, Male, Pituitary Gland, Risk Factors, Sex Factors, Testosterone, Thyroxine, Weight Gain, Prevalence, Human Growth Hormone, Young Adult
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