Hypopituitarism in childhood and adolescence following traumatic brain injury: The case for prospective endocrine investigation
Abstract
Pituitary dysfunction is now well recognised after traumatic brain injury (TBI) in adults; however, little except anecdotal evidence is known about this potential complication in childhood and adolescence. Histopathological evidence exists for both hypothalamic and pituitary damage, but few data specific to children have been published. We review the available paediatric data, which shows that after both mild and severe TBI, hypopituitarism may occur, with GH and gonadotrophin deficiencies appearing to be most common. Precocious puberty has also been documented. Road-traffic accidents, falls, sport and child abuse are the most common aetiological factors for paediatric TBI. There are no published data on the incidence or prevalence, neither within a population of children with TBI, of hypopituitarism, nor on its natural history or response to hormone replacement. We urge paediatric endocrinologists, in collaboration with adult endocrinologists, to perform formal prospective research studies in patients suffering from TBI to clarify these questions.
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TBI can trigger substantial neuroendocrine alterations, often manifesting days to months after the initial insult.
“Beyond the immediate structural and functional cerebral damage, TBI can trigger substantial neuroendocrine alterations, often manifesting days to months after the initial insult [5,6,7].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
The lack of standardized diagnostic criteria and follow-up protocols has significantly contributed to the heterogeneity of findings on GHD after pediatric TBI.
“The lack of standardized diagnostic criteria and follow-up protocols has significantly contributed to the heterogeneity of findings [6,29].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
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 [6]
Many endocrine sequelae after pediatric TBI manifest months to years after the initial trauma, complicating timely diagnosis.
“Importantly, many endocrine sequelae manifest months to years after the initial trauma, complicating a timely diagnosis.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
Post-traumatic endocrine dysfunction is an underrecognized but clinically significant sequela of pediatric TBI with potential long-term consequences for growth, puberty, metabolism, and quality of life.
“Beyond acute neurological injury, post-traumatic endocrine dysfunction has emerged as an underrecognized but clinically significant sequela, with potential long-term consequences for growth, puberty, metabolism, and overall quality of life.”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
The presence of pituitary dysfunction one year after TBI was significantly associated with increased likelihood of persistent pituitary abnormalities or subsequent CPP more than five years after the initial trauma.
“Importantly, the presence of pituitary dysfunction one year after TBI was significantly associated with increased likelihood of persistent pituitary abnormalities or subsequent CPP more than five years after the initial trauma [6,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
Another factor contributing to inconsistent findings is the lack of adequate long-term follow-up in many studies, which is essential for detecting delayed or evolving hormonal deficiencies.
“Another factor contributing to inconsistent findings is the lack of adequate long-term follow-up in many studies, which is essential for detecting delayed or evolving hormonal deficiencies [6,29,32].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
Dassa et al. observed that 4 out of 61 patients (6.6%) developed CPP at a median interval of 5.7 years (range: 2.4-6.1 years) after the traumatic event.
“For instance, Dassa et al. observed that 4 out of 61 patients (6.6%) developed CPP at a median interval of 5.7 years (range: 2.4–6.1 years) after the traumatic event [6,27].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
Only a small number of pediatric cases have been documented, and the occurrence of acute DI in children has been associated with a poorer prognosis.
“Only a small number of pediatric cases have been documented, and the occurrence of acute DI in children has been associated with a poorer prognosis [6].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
In the majority of cases, alterations in water balance are transient and resolve spontaneously within days to weeks after the injury.
“In the majority of cases, these alterations in water balance are transient and resolve spontaneously within days to weeks after the injury [6].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
While DI often develops within hours to days post-injury, its onset may be delayed, sometimes occurring up to 30 days following TBI.
“While DI often develops within hours to days post-injury, its onset may be delayed, sometimes occurring up to 30 days following TBI [6].”
From Endocrine Dysfunctions After Pediatric Traumatic Brain Injury: Present Insights and Future Directions (2025) · cites this paper as [6]
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“Only a small number of pediatric cases have been documented, and the occurrence of acute DI in children has been associated with a poorer prognosis [6].”
Influential
- Authors
- Acerini, C. L., Tasker, R. C., Bellone, S., Bona, G., Thompson, C. J., & Savage, M. O.
- Affiliations
- University of Cambridge (GB)
- Beaumont Hospital (IE)
- Queen Mary University of London (GB)
- Corresponding author
- Savage, Martin O
- ORCID
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-11
- Volume
- 155
- Issue
- 5
- Pages
- 663-669
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2117725706
- Cited by
- 65
- References
- 50
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 2 · 2022: 2 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 4 · 2014: 3 · 2013: 1 · 2012: 11
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (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
- hypopituitarism, traumatic brain injury, pediatric brain injury, adolescents, growth hormone deficiency, gonadotropin deficiency, precocious puberty, hypothalamic injury, hormone replacement therapy, traffic accidents, falls, sports injuries, child abuse
- MeSH terms
- Adolescent, Adult, Brain Injuries, Child, Child, Preschool, Diabetes Insipidus, Female, United Kingdom, Humans, Hypopituitarism, Hypothalamus, Infant, Male, Medical History Taking, Pituitary Gland, Puberty, Precocious
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