The Prevalence of Pituitary Dysfunction in Children Following Severe Traumatic Brain Injury in the Acute Phase

Main Article Content

Adil Rabi
Abdelali Tali
Said Younous
Laila Chabaa

Abstract

Neuro-endocrine disorders are a frequent complication of head trauma. The exploration of these disturbances is important because it can contribute to the understanding of some symptoms presented by the patients for better management in the acute phase or during the evolution.

Aim: The objective of this study was to identify the anterior pituitary dysfunction of severe traumatic brain injury and to analyze the correlations between these disorders, brain lesions and clinical signs.

Materials and Methods: This is a prospective and descriptive study, conducted in collaboration between the pediatric intensive care unit and the clinical biochemistry laboratory of the Mohammed VI University Hospital of Marrakech. This study was spread over 9 months. It Included children admitted for severe head trauma and with a clinical, hormonal and CT scan. And the interest was in 28 severely traumatized skulls in the acute phase. All patients received TSH, T3, T4, Prolactin and cortisol levels 8 hours after admission.

Results: There were twenty eight patients included in the study. Sex ratio m / f of 1.54, whose age varies between 9 months and 14 years, with an average age of 6.5 years. Half of the patients had an initial Glasgow score of 8/15. This was cerebral oedema in (46.42%) cases. In this study, the rate of endocrine disorders was 85.71%, the exploration of the thyrotropic axis proved normal in all of these patients. Low cortisol levels were observed in 11% of cases, 67.84% of children had hyperprolactinemia. One-third of the patient included in the study had 2-axis involvement, namely cortisol and prolactin. Half, on the other hand, showed only one axis.

Conclusion: In the aftermath of head trauma, pituitary disturbances are frequent and should be included in their management.

Keywords:
Anterior pituitary, axes, dysfunctions, trauma

Article Details

How to Cite
Rabi, A., Tali, A., Younous, S., & Chabaa, L. (2020). The Prevalence of Pituitary Dysfunction in Children Following Severe Traumatic Brain Injury in the Acute Phase. Journal of Advances in Medicine and Medical Research, 32(1), 89-94. https://doi.org/10.9734/jammr/2020/v32i130355
Section
Original Research Article

References

Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: Emergency Department Visits, Hospitalizations and Deaths, 2002–2006. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

Shao J, Zhu H, Yao H, et al. Characteristics and trends of pediatric traumatic brain injuries treated at a large pediatric medical centre in China, 2002–2011. PLoS One. 2012;7(12):e51634.

Einaudi S, Matarazzo P, Peretta P, et al. Hypothalamo-hypopysial dysfunction after traumatic brain injury in children and adolescents: A preliminary retrospective and prospective study. J Pediatr Endocrinol Metab. 2006;19(44):691–703.

Edwige Y, Christine CR. Explorations endocriniennes des traumatismes crâ- niens: A quelle fréquence? Med Clin Endocrinol Diab. 2010;48(1):18-23.

Ducrocq SC, Meyer PG, Orliaguet GA, et al. Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: Experience of a French pediatric trauma center. Pediatr Crit Care Med. 2006;7(5):461–467.

Ghigo E, Masel B, Aimaretti G, et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj. 2005;19(9):711-24.

Niederland T, Makovi H, Gal V, et al. Abnormalities of pituitary function after traumatic brain injury in children. J Neurotrauma. 2007;24(1):119–127.

Phoomtavorn P, Maixner W, Zacharin M. Pituitary function in paediatric survivors of severe traumatic brain injury. Arch Dis Child. 2008;93(2):133–137.

Somrani R. Devenir endocrinien et neurologique à moyen terme des enfants hospitalisés en réanimation pédiatrique pour traumatisme crânien. Mémoire des de pédiatrie. Université Joseph Fourier Grenoble CHU Grenoble; 2009.

Heather NL, Jefferies C, Hofman PL, et al. Permanent hypopituitarism is rare after structural traumatic brain injury in early childhood. J Clin Endocrinol Metab. 2012;97(2):599–604.

Bethany A. Auble, Sureka Bollepalli, et al. Hypopituitarism in pediatric survivors of inflicted traumatic brain injury. Journal of Neurotrauma. 2014;31(14):321–326.

Tanriverdi F, Senyurek H, Unluhizarci K, Selcuklu F, et al. High risk of hypopituitarism after traumatic brain injury: A prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma. J Clin Endocrinol Metab. 2006;91(6):2105-11. Epub 2006 Mar 7.

Kaulfers AM, Backeljauw PF, Reifschneider K, et al. Endocrine dysfunction following traumatic brain injury in children. J. Pediatr. 2010;157(6):894–899.

Dons RF. Thyrotropin (TSH) surge test. In: Endocrine and Metabolic Testing Manual, 3rd Ed. CRC Press: New York. 1998;8–10.

Rose SR. Clinical utility of time-of-day normal ranges for TSH. J Pediatr. 2010;157(4):662-667.

Carroll CP, Cochran JA, Price JP, Guse CE, et al. The AIS-2005 Revision in severe traumatic brain injury: Mission accomplished or problems for future research. Ann. Adv. Automot. Med. 2010;54(1):233–238.

Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, et al. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: A systematic review. JAMA. 2007;298(12):1429-38.

Kelly DF, Gonzalo IT, Cohan P, et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: A preliminary report. Journal of Neurosurgery. 2000;93(1):743-751.

Agha A, Rogers B, Sherlock M, et al. Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab. 2004;89(10):4929-36.

Aimaretti G, Ambrosio MR, Di Somma C, et al. Residual pituitary function after brain injury-induced hypopituitarism: A prospective 12-month study. J Clin Endocrinol Metab. 2005;90(11):6085–92.

Klose M, Juul A, Struck J, Morgenthaler NG, et al. Acute and long-term pituitary insufficiency in traumatic brain injury: A prospective single-centre study. Clin Endocrinol (Oxf). 2007;67(4):598-606.