medwireNews: Research shows that growth hormone deficiency (GHD) and central precocious puberty can occur in children several years after traumatic brain injury (TBI), even among those with normal pituitary function 1 year after the event.
From their original cohort of 87 children with TBI, Hélène Crosnier (Hôpital Universitaire Necker-Enfants Malades, Paris, France) and colleagues were able to follow-up 61 for at least 5 years, which they stress is a high retention rate for the follow-up duration.
The 52 children with accidental TBI sustained it at a median age of 7.8 years; a further five had TBI inflicted at a median age of 0.5 years.
The researchers previously found that 33% of the original 87 children had pituitary dysfunction at 1 year after the TBI.
As reported in the European Journal of Endocrinology, this proved to be a transient complication for many patients. Of the 17 in the longer-term study who had 1-year pituitary dysfunction, 12 had normal GH secretion by the 5-year follow-up, and all had normal height velocity.
However, GHD persisted in five patients, four of whom required GH treatment.
Given the high risk for persistent pituitary dysfunction in this group, the team says: “Our results lead us to recommend hormonal assessment including dynamic GH testing in children one-year after severe TBI.”
But they also found that problems could develop in patients initially thought to have escaped endocrine problems; GHD developed in a child who had normal pituitary function 1 year post-TBI, identified 6.6 years later via “routine clinical follow-up of growth”.
In addition, four patients had central precocious puberty, diagnosed a median of 5.7 years after TBI, two of whom had normal pituitary function when assessed 1 year post-TBI. The two with initial GHD had normal pituitary function at later assessments. There were no cases of delayed puberty.
Two children required prolonged thyroxine treatment for thyroid dysfunction, and one received hydrocortisone for 5.7 years, after which adrenal function normalised.
The researchers found no way to predict which children would develop GHD or precocious puberty, finding no relationship between post-TBI imaging and later endocrine outcomes. However, they note that few of the children in their study underwent magnetic resonance imaging, which would give the most sensitive measures of brain damage.
“Unfortunately, severe TBI in children is not a rare event, thus prolonged endocrine evaluation of all these patients is a challenge,” say Crosnier and team.
The researchers note that although pituitary dysfunction and precocious puberty affect only a minority of these patients, these “may contribute significantly to the morbidity following severe TBI”. They advise “a coordinated approach”, involving the family and multidisciplinary healthcare professionals, to monitor children for growth impairment or precocious puberty.
By Eleanor McDermid
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J Clin Endocrinol Metab 2019; doi:10.1530/EJE-19-0034