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Pituitary Response to Traumatic Brain Injury

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Pituitary Disorders of Childhood

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

There is robust evidence supporting pituitary dysfunction after traumatic brain injury (TBI) in adults. Traumatic injury to the pituitary gland and hypothalamus with subsequent hormonal abnormalities has a multifaceted pathophysiology. While TBI is among the most common health problems of childhood, the evidence for endocrinopathies has been limited until recently. In this chapter, we provide a review of the available studies regarding pituitary function following TBI. The body of literature is complicated by multiple approaches to diagnostic testing, heterogeneity in the patient population, and the severity of brain injury. There are several papers which report no pituitary deficits, likely reflecting a lower incidence of disease in the pediatric population as compared with adults. Given the significant burden of pediatric TBI, accurate and cost-effective endocrine screening recommendations are crucial. We conclude that more investigation into consistent and accurate diagnostic testing is needed. Additionally, long-term data is needed regarding the outcomes of hormone replacement in the multitude of TBI-induced pituitary deficits.

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References

  1. Cyran E. Hypophysenschadigung durch Schadelbasisfraktur. Dtsch Med Wschr. 1918;44:1261.

    Google Scholar 

  2. Lauzier F, Turgeon AF, Boutin A, Shemilt M, Côté I, Lachance O, Archambault PM, Lamontagne F, Moore L, Bernard F, Gagnon C, Cook D. Clinical outcomes, predictors, and prevalence of anterior pituitary disorders following traumatic brain injury: a systematic review. Crit Care Med. 2014;42(3):712–21.

    Article  Google Scholar 

  3. Paxson CL Jr, Brown DR. Post-traumatic anterior hypopituitarism. Pediatrics. 1976;57(6):893–6.

    PubMed  Google Scholar 

  4. Girard J, Marelli R. Posttraumatic hypothalamo-pituitary insufficiencyDiagnostic and therapeutic problems in a prepubertal child. J Pediatr. 1997;90:241–2.

    Article  Google Scholar 

  5. Gnehm HE, Bernasconi S, Zachmann M. Posttraumatic anterior pituitary insufficiency in childhood. Helv Pediatr Acta. 1979;34:529–35.

    CAS  Google Scholar 

  6. Miller W, Kaplan SL, Grumbach MM. Child abuse as a cause of posttraumatic hypopituitarism. N Engl J Med. 1980;302:724–8.

    Article  CAS  Google Scholar 

  7. Valenta LJ, De Feo DR. Posttraumatic hypopituitarism due to a hypothalamic lesion. Am J Pediatr. 1980;68:614–7.

    CAS  Google Scholar 

  8. Eichler I, Frisch H, Eichler HG, Soukop W. Isolated growth hormone deficiency after severe head trauma. J Endocr Invest. 1988;11:409–11.

    Article  CAS  Google Scholar 

  9. Lim HS, Ang BK, Ngim RC. Hypopituitarism following head injury – a case report. Ann Acad Med Singap. 1990;19:851–5.

    CAS  PubMed  Google Scholar 

  10. Yamanaka C, Momoi T, Fujisawa I, et al. Acquired growth hormone deficiency due to pituitary stalk transection after head trauma in childhood. Eur J Pediatr. 1993;152:99–101.

    Article  CAS  Google Scholar 

  11. Mariani R, Bortoluzzi MN, Richelme C, et al. Posttraumatic hypopituitarism after skull injury: apropos of three cases. Arch Pediatr. 1996;3:796–801.

    Article  CAS  Google Scholar 

  12. Grossman WF, Sanfield JA. Hypothalamic atrophy presenting as amenorrhea and sexual infantilism in a female adolescent. A case report. J Reprod Med. 1994;39:738–40.

    CAS  PubMed  Google Scholar 

  13. Barbeau C, Jouret B, Gallegos D, et al. Syndrome d’interruption de la tige pituitaire. [pituitary stalk transection. Arch Fr Ped. 1998;5:274–9.

    Article  CAS  Google Scholar 

  14. Dogru O, Koken R, Bukulmez A, et al. Delay in diagnosis of hypopituitarism after traumatic head injury: a case report and a review of the literature. Neuro Endocrinol Lett. 2005;26:311–3.

    CAS  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  16. Poomthavorn P, Zacharin M. Traumatic brain injury-mediated hypopituitarism. Report of four cases. Eur J Pediatr. 2007;166:1163.

    Article  Google Scholar 

  17. Einaudi S, Bondone C. The effects of head trauma on hypothalamic-pituitary function in children and adolescents. Curr Opin Pediatr. 2007 Aug;19(4):465–70.

    Article  Google Scholar 

  18. Dewan MC, Mummareddy N, Wellons JC 3rd, Bonfield CM. Epidemiology of global pediatric traumatic brain injury: qualitative review. World Neurosurg. 2016;91:497–509.

    Article  Google Scholar 

  19. Guaraldi F, Grottoli S, Arvat E, Ghigo E. Hypothalamic-pituitary autoimmunity and traumatic brain injury. J Clin Med. 2015;4(5):1025–35.

    Article  CAS  Google Scholar 

  20. Tanriverdi F, De Bellis A, Bizzarro A, et al. Antipituitary antibodies after traumatic brain injury: is head trauma-induced pituitary dysfunction associated with autoimmunity? Eur J Endocrinol. 2008;159:7–13.

    Article  CAS  Google Scholar 

  21. Casanueva FF, Ghigo E, Polak M, Savage MO. The importance of investigation of pituitary function in children and adolescents following traumatic brain injury. J Endocrinol Investig. 2006;29(8):764–6.

    Article  CAS  Google Scholar 

  22. Srinivas R, Brown SD, Chang YF, Garcia-Fillion P, Adelson PD. Endocrine function in children acutely following severe traumatic brain injury. Childs Nerv Syst. 2010;26(5):647–53.

    Article  Google Scholar 

  23. Dupuis C, Thomas S, Faure P, Gayot A, Desrumaux A, Wroblewski I, Debillon T, Emeriaud G. Secondary adrenal insufficiency in the acute phase of pediatric traumatic brain injury. Intensive Care Med. 2010 Nov;36(11):1906–13.

    Article  CAS  Google Scholar 

  24. Aimaretti G, Ambrosio MR, Di Somma C, Gasperi M, Cannavò S, Scaroni C, De Marinis L, Baldelli R, Bona G, Giordano G, Ghigo E. Hypopituitarism induced by traumatic brain injury in the transition phase. J Endocrinol Investig. 2005;28(11):984–9.

    Article  CAS  Google Scholar 

  25. Niederland T, Makovi H, Gál V, Andréka B, Abrahám CS, Kovács J. Abnormalities of pituitary function after traumatic brain injury in children. J Neurotrauma. 2007;24(1):119–27.

    Article  Google Scholar 

  26. Poomthavorn P, Maixner W, Zacharin M. Pituitary function in paediatric survivors of severe traumatic brain injury. Arch Dis Child. 2008;93(2):133–7.

    Article  CAS  Google Scholar 

  27. Norwood KW, Deboer MD, Gurka MJ, Kuperminc MN, Rogol AD, Blackman JA, Wamstad JB, Buck ML, Patrick PD. Traumatic brain injury in children and adolescents: surveillance for pituitary dysfunction. Clin Pediatr (Phila). 2010;49(11):1044–9.

    Article  Google Scholar 

  28. Kaulfers AM, Backeljauw PF, Reifschneider K, Blum S, Michaud L, Weiss M, Rose SR. Endocrine dysfunction following traumatic brain injury in children. J Pediatr. 2010;157(6):894–9.

    Article  CAS  Google Scholar 

  29. Casano-Sancho P, Suárez L, Ibáñez L, García-Fructuoso G, Medina J, Febrer A. Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment? Clin Endocrinol. 2013;79(6):853–8.

    Article  CAS  Google Scholar 

  30. Auble BA, Bollepalli S, Makoroff K, Weis T, Khoury J, Colliers T, Rose SR. Hypopituitarism in pediatric survivors of inflicted traumatic brain injury. J Neurotrauma. 2014;31(4):321–6.

    Article  Google Scholar 

  31. 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. Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolescents: a large prospective study. J Clin Endocrinol Metab. 2014;99(6):2052–60.

    Article  CAS  Google Scholar 

  32. Krahulik D, Aleksijevic D, Smolka V, Klaskova E, Venhacova P, Vaverka M, Mihal V, Zapletalova J. Prospective study of hypothalamo-hypophyseal dysfunction in children and adolescents following traumatic brain injury. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017;161(1):80–5.

    Article  Google Scholar 

  33. Gandrud LM, Wilson DM. Is growth hormone stimulation testing in children still appropriate? Growth Hormon IGF Res. 2004;14(3):185–94.

    Article  Google Scholar 

  34. Stanley TL, Levitsky LL, Grinspoon SK, Misra M. Effect of body mass index on peak growth hormone response to provocative testing in children with short stature. J Clin Endocrinol Metab. 2009;94(12):4875–81.

    Article  CAS  Google Scholar 

  35. Ghigo E, Masel B, Aimaretti G, Léon-Carrión J, Casanueva FF, Dominguez-Morales MR, Elovic E, Perrone K, Stalla G, Thompson C, Urban R. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj. 2005;19(9):711–24.

    Article  CAS  Google Scholar 

  36. Khadr SN, Crofton PM, Jones PA, Wardhaugh B, Roach J, Drake AJ, Minns RA, Kelnar CJ. Evaluation of pituitary function after traumatic brain injury in childhood. Clin Endocrinol. 2010;73(5):637–43.

    Article  CAS  Google Scholar 

  37. Moon RJ, Sutton T, Wilson PM, Kirkham FJ, Davies JH. Pituitary function at long-term follow-up of childhood traumatic brain injury. J Neurotrauma. 2010;27(10):1827–35.

    Article  Google Scholar 

  38. Heather NL, Jefferies C, Hofman PL, Derraik JG, Brennan C, Kelly P, Hamill JK, Jones RG, Rowe DL, Cutfield WS. Permanent hypopituitarism is rare after structural traumatic brain injury in early childhood. J Clin Endocrinol Metab. 2012;97(2):599–604.

    Article  CAS  Google Scholar 

  39. Salomón-Estébanez MA, Grau G, Vela A, Rodríguez A, Morteruel E, Castaño L, Rica I. Is routine endocrine evaluation necessary after paediatric traumatic brain injury? J Endocrinol Investig. 2014;37(2):143–8.

    Article  Google Scholar 

  40. Ulutabanca H, Hatipoglu N, Tanriverdi F, Gökoglu A, Keskin M, Selcuklu A, Kurtoglu S, Kelestimur F. Prospective investigation of anterior pituitary function in the acute phase and 12 months after pediatric traumatic brain injury. Childs Nerv Syst. 2014;30(6):1021–8.

    Article  Google Scholar 

  41. Aylanç H, Tütüncüler F, Süt N. Evaluation of pituitary function in cases with the diagnosis of pediatric mild traumatic brain injury: cross-sectional study. J Neurosci Rural Pract. 2016;7(4):537–43.

    Article  Google Scholar 

  42. Rose SR, Auble BA. Endocrine changes after pediatric traumatic brain injury. Pituitary. 2012;15(3):267–75.

    Article  CAS  Google Scholar 

  43. Bellone S, Einaudi S, Caputo M, Prodam F, Busti A, Belcastro S, Parlamento S, Zavattaro M, Verna F, Bondone C, Tessaris D, Gasco V, Bona G, Aimaretti G. Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury. Pituitary. 2013;16(4):499–506.

    Article  CAS  Google Scholar 

  44. Casano-Sancho P. Pituitary dysfunction after traumatic brain injury: are there definitive data in children? Arch Dis Child. 2017;102(6):572–7.

    Article  Google Scholar 

  45. Karaca Z, Laway BA, Dokmetas HS, Atmaca H, Kelestimur F. Sheehan syndrome. Nat Rev Dis Primers. 2016;2:16092. https://doi.org/10.1038/nrdp.2016.92.

    Article  PubMed  Google Scholar 

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Acknowledgements

Dr. Lal is a Stephen Bechtel Endowed Adult and Pediatric Endocrinology Fellow through the Stanford Child Health Research Institute and is supported by a Diabetes, Endocrinology and Metabolism Training Grant (T32 DK007217) from NIDDK.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Stanford University, Stanford, CA, USA

    Rayhan A. Lal & Andrew R. Hoffman

  2. Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, USA

    Rayhan A. Lal

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  1. Rayhan A. Lal
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  2. Andrew R. Hoffman
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Correspondence to Rayhan A. Lal .

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Editors and Affiliations

  1. Division of Pediatric Endocrinology, New York University, New York, NY, USA

    Brenda Kohn

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Lal, R.A., Hoffman, A.R. (2019). Pituitary Response to Traumatic Brain Injury. In: Kohn, B. (eds) Pituitary Disorders of Childhood. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-030-11339-1_18

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  • DOI: https://doi.org/10.1007/978-3-030-11339-1_18

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-030-11338-4

  • Online ISBN: 978-3-030-11339-1

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