Endocrine Dysfunction following Traumatic Brain Injury in Children

Objective

To identify the incidence of endocrine dysfunction in children following traumatic brain injury (TBI).

Study design

This was a prospective evaluation of 31 children after TBI. Inclusion criteria included Glasgow Coma Scale score ≤12 and age 1.5-18 years. We evaluated thyroid function, insulin-like growth factor I, insulin-like growth factor-binding protein 3, and cortisol at 1, 3, 6, and 12 months after injury, and assessed prolactin at 3 and 6 months. At 6 months, we also assessed overnight spontaneous growth hormone secretion, nocturnal thyrotropin surge, adrenal reserve, and serum and urine osmolarity.

Results

The average patient age was 11.6 years, and mean Glascow Coma Scale score was 6. The incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months. At 12 months after injury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency. Endocrine dysfunction at 1 year did not correlate with the severity of injury.

Conclusions

Endocrine dysfunction after TBI is common in children, but most cases resolve by 1 year. We recommend endocrine surveillance at both 6 and 12 months following moderate or severe TBI to ensure early intervention for persistent or late-occurring endocrine sequelae.

ACTH, Adrenocorticotropic hormone, CV, Coefficient of variation, DI, Diabetes insipidus, FSH, Follicle-stimulating hormone, GCS, Glasgow Coma Scale, GH, Growth hormone, IGFBP-3, Insulin-like growth factor binding protein 3, IGF-1, Insulin-like growth factor I, LH, Luteinizing hormone, SD, Standard deviation, T4, Thyroxine, TBI, Traumatic brain injury, TSH, Thyroid-stimulating hormone