Investigators at Cincinnati Children's Hospital, OH, studied the prevalence of hypopituitarism in children with inflicted traumatic brain injury. Of 14 patients evaluated, 86% had at least one endocrine dysfunction, and 50% had 2 or more, a significant increase compared to the general population, estimated to have 2.5% with endocrine abnormality. Elevated prolactin occurred in 64%, abnormal thyroid in 33%, short stature (29%), and low nocturnal growth hormone peak (17%). A child with a history of inflicted TBI should be followed closely for growth velocity and pubertal changes. If growth velocity is slow, prolactin level and full endocrine evaluation are indicated. [1]

COMMENTARY. Hypopituitarism after traumatic brain injury occurs frequently in adults, whereas in children the reported prevalence is variable. In a large study of 89 adults, aged 18-65 years (mean age 36 years), hormonal function evaluated at the time of injury and at 3, 6, and 12 months postinjury showed primary hormonal dysfunction in 19 patients (21%). Major deficits included growth hormone dysfunction, hypogonadism, and diabetes insipidus. MR imaging demonstrated increased frequency of empty sella syndrome in patients with hormonal dysfunction [2].

In children, endocrine dysfunction after TBI is common, but most cases resolve by 1 year. In one study of 31 children, average age 11.6 years, the incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months. At 12 months postinjury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency. Endocrine dysfunction does not correlate with severity of injury [3]. In a retrospective study of 33 children with accidental head injury (27 boys), only minor pituitary hormone abnormalities were observed, unrelated to the severity of TBI, and no clinically significant endocrinopathy was identified [4].

Age of occurrence of the TBI appears to be a significant risk factor for postinjury endocrinopathy. In children and adults, endocrine surveillance at 6 and 12 months following moderate or severe TBI is recommended, but in contrast to adults, systematic screening for hormonal dysfunction in children is generally unnecessary [3, 4]. A child with a history of inflicted TBI is an exception, and if on follow-up growth velocity is slowed, prolactin level and a full endocrine evaluation should be performed [1].