Hypothalamo-hypophysial dysfunction after traumatic brain injury in children and adolescents: A preliminary retrospective and prospective study
Abstract
With two study protocols, one retrospective and the other prospective, we evaluated hypothalamo-hypophysial dysfunction (HHD) in paediatric patients treated for traumatic brain injury (TBI) in the neurosurgical or intensive care department at our hospital. The retrospective group comprised 22 patients who had experienced TBI 0.7-7.25 years before the study. The prospective group included 30 patients assessed at TBI (T0), 26 of 30 after 6 months (T6), and 20 of 26 after 12 months (T12). Auxological and hormonal basal parameters of hypothalamo-hypophysial function were evaluated at recall in the retrospective group, and at T0, T6 and T12 in the prospective group. Basal data and standard dynamic tests in selected patients revealed one with precocious puberty, one with total anterior hypopituitarism, one with central hypogonadism, and one with growth hormone (GH) deficiency in the retrospective group; three patients with cerebral salt-wasting syndrome, one with diabetes insipidus and seven with low T3 syndrome at T0 (all transient), one with hypocorticism at T6 confirmed at T12, and one with GH deficiency at T12 in the prospective group. The results of our study show that post-TBI HHD in our paediatric cohort is not uncommon. Of the 48 patients who underwent a complete evaluation (22 retrospective study patients and 26 prospective study patients evaluated at T6) five (10.4%) developed HHD 6 months or more after TBI. HHD was newly diagnosed in one previously normal patient from the prospective group at 12 months after TBI. GH deficiency was the most frequent disorder in our paediatric cohort.
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A retrospective study found no children with low cortisol levels acutely after TBI.
“In contrast, a retrospective study found no children with low cortisol levels acutely after TBI [34].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
Einaudi prospectively studied 30 children at 0, 6, and 12 months after injury; incidence of endocrine dysfunction was 23% at baseline, 4% at six months, and 10% at twelve months.
“Einaudi [34] prospectively studied 30 children (average age of 9 years old) at 0, 6, and 12 months after injury. At baseline after injury, the incidence of endocrine dysfunction was 23%. At six months, the incidence was 4%, with one patient having ACTH deficiency. At twelve months, the incidence was 10% (n = 2), with one patient having a new diagnosis of GHD, and one continuing to have ACTH defic”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
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 [34]
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 [34]
Combined with retrospective data from the same study, the incidence of some degree of hypopituitarism was 10.4% at six months after injury.
“Combined with the retrospective data from the same study, the incidence of some degree of hypopituitarism was 10.4% at six months after injury.”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
Among prospective studies in children, Einaudi reported one of 30 patients with GHD at 12 months (3%).
“Among the prospective studies in children, Einaudi [34] reported one of 30 patients with GHD at 12 months (3%).”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
Einaudi found 23% of children transiently had low Free T3 acutely after injury.
“Einaudi found similar results with 23% of children transiently having low Free T3 acutely after injury [34].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
Einaudi et al. reported thyroid dysfunction in seven patients (23%) during the acute post-TBI phase, which completely resolved within six months of follow-up.
“Einaudi et al. reported thyroid dysfunction in seven patients (23%) during the acute post-TBI phase, which completely resolved within six months of follow-up [18].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [18]
Einaudi et al. reported that among children with moderate TBI, some initially diagnosed with GHD showed improvement in GH secretion within the first two years post-injury.
“Similarly, Einaudi et al. reported that among children with moderate TBI, some initially diagnosed with GHD showed improvement in GH secretion within the first two years post-injury.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [18]
Niederland et al., in a cross-sectional analysis of 26 children assessed at 30 ± 8 months, observed pituitary abnormalities in 61%.
“Niederland et al., in a cross-sectional analysis of 26 children assessed at 30 ± 8 months, observed pituitary abnormalities in 61% [18,19].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [18]
In a mixed retrospective and prospective study of 48 children with TBI, Einaudi et al. reported HPA dysfunction in 10% of cases at 12 months.
“In a mixed retrospective and prospective study of 48 children with TBI, Einaudi et al. reported HPA dysfunction in 10% of cases at 12 months, while Niederland et al., in a cross-sectional analysis of 26 children assessed at 30 ± 8 months, observed pituitary abnormalities in 61% [18,19].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [18]
In Einaudi et al.'s retrospective cohort, hypogonadism was identified in 9% of children between one and four years post-injury, whereas the prospective cohort revealed no cases at the one-year follow-up.
“In the retrospective cohort, hypogonadism was identified in 9% of children between one and four years post-injury, whereas the perspective cohort revealed no cases of hypogonadism at the one-year follow-up [18].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [18]
Retrospectively, Einaudi found a 9% incidence of hypogonadism at one to four years after injury in children, while prospectively, the study found no cases of hypogonadism at one year after injury.
“Retrospectively, the study found a 9% incidence of hypogonadism at one to four years after injury in children, while prospectively, the study found no cases of hypogonadism at one year after injury [34].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
Einaudi found one child (5%) with precocious puberty five years after injury.
“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 [34]
In a prospective study by Einaudi, two patients had low basal cortisol levels at six months after injury, only one failed a glucagon stimulation test, and ACTH deficiency was confirmed in that patient at 12 months after TBI.
“In a prospective study by Einaudi, two patients had low basal cortisol levels at six months after injury, only one of whom failed a glucagon stimulation test; ACTH deficiency was confirmed in that patient at 12 months after TBI [34].”
From Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury (2015) · cites this paper as [34]
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- Authors
- Einaudi, S., Matarazzo, P., Peretta, P., Grossetti, R., Giordano, F., Aitare, F., Bondone, C., Andreo, M., Ivani, G., Genitori, L., & de Sanctis, C.
- Affiliations
- Ospedale Regina Margherita (IT)
- Venue
- Journal of Pediatric Endocrinology and Metabolism
- Publisher
- Walter de Gruyter GmbH
- Published
- 2006-01
- Volume
- 19
- Issue
- 5
- Pages
- 691-703
- ISSN
- 0334-018X (ISSN-L)
- 2191-0251
- OpenAlex
- W1992058795
- Cited by
- 106
- References
- 10
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 7 · 2019: 7 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 2 · 2014: 9 · 2013: 7 · 2012: 11
- FWCI
- 4.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Endocrinology and Metabolism (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 › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Keywords
- traumatic brain injury, pediatric patients, children and adolescents, growth hormone deficiency, anterior hypopituitarism, precocious puberty, central hypogonadism, cerebral salt wasting syndrome, diabetes insipidus, low T3 syndrome, hypocorticism, hypothalamic-pituitary-adrenal axis
- MeSH terms
- Adolescent, Age Determination by Skeleton, Brain Injuries, Child, Child, Preschool, Dehydration, Female, Glucagon, Growth, Humans, Hydrocortisone, Hypopituitarism, Hypothalamic Diseases, Hypothalamo-Hypophyseal System, Infant, Gonadotropin-Releasing Hormone, Male, Pituitary Function Tests, Pituitary Hormones, Prolactin, Prospective Studies, Retrospective Studies, Tomography, X-Ray Computed, Glasgow Coma Scale
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