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Cited by 43Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsTraumatic Brain Injury and Neurovascular Disturbances

Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolescents: A large prospective study

Personnier, Claire, Crosnier, Hélène, Meyer, Philippe, Chevignard, Mathilde, Flechtner, Isabelle, Boddaert, Nathalie, Breton, Sylvain, Mignot, Caroline +9 more·2014·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2013-4129
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Abstract

CONTEXT: Traumatic brain injury (TBI) in childhood is a major public health issue. OBJECTIVE: We sought to determine the prevalence of pituitary dysfunction in children and adolescents after severe TBI and to identify any potential predictive factors. DESIGN: This was a prospective longitudinal study. SETTING: The study was conducted at a university hospital. PATIENTS: Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months after the injury. MAIN OUTCOME MEASURES: Basal and dynamic tests of pituitary function were performed in all patients and GH dynamic testing was repeated in patients with low stimulated GH peak (<7 ng/mL). The diagnosis of proven severe GH deficiency (GHD) was based on the association of two GH peaks less than 5 ng/mL on both occasions of testing and IGF-I levels below -2 SD score. Initial cranial tomography or magnetic resonance imaging was analyzed retrospectively. RESULTS: We studied 87 children and adolescents [60 males, median age 6.7 y (range 0.8-15.2)] 9.5 ± 3.4 months after the TBI (73 accidental, 14 inflicted). The second GH peak, assessed 4.9 ± 0.1 months after the first evaluation, remained low in 27 children and adolescents. Fifteen patients had a GH peak less than 5 ng/mL (mean IGF-I SD score -1.3 ± 1.5) and five (5.7%) strict criteria for severe GHD. Two children had mild central hypothyroidism and one had ACTH deficiency. We did not find any predictive factors associated with existence of GHD (demographic characteristics, growth velocity, trauma severity, and radiological parameters). CONCLUSION: At 1 year after the severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after a severe TBI and prolonged clinical endocrine follow-up.

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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 [49]

  • Personnier prospectively followed 87 children and adolescents hospitalized for severe TBI; initial assessment demonstrated GH peak <7 ng/mL in 40%, six with low FT4, and one with low cortisol.

    “Personnier [49] prospectively followed 87 children and adolescents hospitalized for severe TBI with follow-up endocrine assessment performed between 6–18 months after injury. Initial assessment demonstrated GH peak <7 ng/mL in 40%, six with low FT4, and one with low cortisol.”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [49]

  • On retesting, TSH deficiency was confirmed in two, and ACTH deficiency in one patient.

    “On retesting, TSH deficiency was confirmed in two, and ACTH deficiency in one patient.”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [49]

  • In prospective studies of children following TBI, only one of 87 exhibited signs of posterior pituitary dysfunction at six months but had appropriate response to fluid deprivation.

    “In prospective studies of children following TBI, only one of 87 exhibited signs of posterior pituitary dysfunction (polyuria, polydipsia) at six months but had appropriate response to fluid deprivation [49].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [49]

  • Prevalence of endocrinopathies at 12 months has not been shown to correlate with severity of injury as measured by the Glasgow Coma Score.

    “Prevalence of endocrinopathies at 12 months has not been shown to correlate with severity of injury as measured by the Glasgow Coma Score [24,47,49].”

    From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [49]

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  1. Sempé, 1979, Auxologie, Méthodes et Séquences

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Authors
Personnier, C., Crosnier, H., Meyer, P., Chevignard, M., Flechtner, I., Boddaert, N., Breton, S., Mignot, C., Dassa, Y., Souberbielle, J.-C., Piketty, M., Laborde, K., Jais, J.-P., Viaud, M., Puget, S., Sainte-Rose, C., & Polak, M.
Affiliations
  • Pediatric Endocrinology, Gynecology, and Diabetology Unit (C.P., H.C., I.F., Y.D., M.V., M.P.), 75015 Paris, France;
  • Pediatric Anesthesiology Unit (P.M.), 75015 Paris, France;
  • Hôpitaux de Saint Maurice (FR)
  • Institut des Maladies Génétiques Imagine (FR)
  • Université Paris Descartes (FR)
  • Radiology Unit (N.B., S.B.), 75015 Paris, France;
  • Functional Explorations Unit (J.-C.S., M.P., K.L.),75015 Paris, France;
  • Hôpital Necker-Enfants Malades (FR)
  • Pediatric Neurosurgery Unit (C.M., S.P., C.S.-R.), 75015 Paris, France;
Corresponding author
  • Crosnier, Hélène
  • Polak, Michel
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2014-06-01
Volume
99
Issue
6
Pages
2052-2060
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2013-4129
OpenAlex
W1977778567
Cited by
43
References
50
Citations by year
2026: 3 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 1 · 2020: 6 · 2019: 7 · 2018: 2 · 2017: 3 · 2016: 3 · 2015: 8
FWCI
3.35
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • University of Southampton
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
pituitary dysfunction, severe traumatic brain injury, children and adolescents, growth hormone deficiency, central hypothyroidism, ACTH deficiency, insulin-like growth factor I, GH stimulation test, endocrine follow-up, injury severity
MeSH terms
Adolescent, Brain Injuries, Child, Child, Preschool, Female, France, Humans, Hypopituitarism, Infant, Infant, Newborn, Longitudinal Studies, Male, Severity of Illness Index, Prevalence, Neuroimaging

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