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Citation
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Personnier C, Crosnier H, Meyer P, Chevignard M, Flechtner I, Boddaert N, Breton S, Mignot C, Dassa Y, Souberbielle JC, Piketty M, Laborde K, Jais JP, Viaud M, Puget S, Sainte-Rose C, Polak M. J. Clin. Endocrinol. Metab. 2014; 99(6): 2052-2060. |
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Affiliation
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Pediatric Endocrinology, Gynecology and Diabetology Unit (C.P., H.C., I.F., Y.D., M.V., M.P.), Pediatric Anesthesiology Unit (P.M.), Radiology Unit (N.B., S.B.), Pediatric Neurosurgery Unit (C.M., S.P., C.S.-R.), Functional Explorations Unit (J.-C.S., M.P., K.L.), Biostatistic Department (J.-P.J.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Necker Enfants-Malades, Paris, France. Rehabilitation department for children with acquired neurological injury, Hôpitaux de St-Maurice, St-Maurice, France (M.C.). Université Paris Descartes, Paris, France (N.B., S.B., S.P., C.S.-R., M.P.). ER6-Université Pierre et Marie Curie, Paris, France (M.C.). IMAGINE Affiliate, Paris, France (N.B., M.P.). |
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Abstract
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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. Prospective longitudinal study. Setting. A University Hospital. Patients. Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months post-injury. Main Outcome Measures. Basal and dynamic tests of pituitary function were performed in all patients and growth hormone (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 <5 ng/ml on both occasion of testing and IGF-1 levels below -2 SDS. Initial computed tomography (CT) or magnetic resonance imaging (MRI) were analyzed retrospectively.
RESULTS. We studied 87 children and adolescents (60 males, median age of 6.7 years [range: 0.8-15.2]) 9.5±3.4 months post-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 GH peak <5 ng/ml (mean IGF-1 SDS -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 one year post-severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after severe TBI and prolonged clinical endocrine follow-up.
Language: en |