TY  - JOUR
PY  - 2014//
TI  - Prevalence of pituitary dysfunction following severe traumatic brain injury in children and adolescents: a large prospective study
JO  - Journal of clinical endocrinology and metabolism
A1  - Personnier, Claire
A1  - Crosnier, Hélène
A1  - Meyer, Philippe
A1  - Chevignard, Mathilde
A1  - Flechtner, Isabelle
A1  - Boddaert, Nathalie
A1  - Breton, Sylvain
A1  - Mignot, Caroline
A1  - Dassa, Yamina
A1  - Souberbielle, Jean-Claude
A1  - Piketty, Marie
A1  - Laborde, Kathleen
A1  - Jais, Jean-Philipe
A1  - Viaud, Magali
A1  - Puget, Stephanie
A1  - Sainte-Rose, Christian
A1  - Polak, Michel
SP  - 2052
EP  - 2060
VL  - 99
IS  - 6
N2  - Context. Traumatic brain injury (TBI) in childhood is a major public health issue. <br><br>OBJECTIVE. We sought to determine the prevalence of pituitary dysfunction in children and adolescents after severe TBI and to identify any potential predictive factors. Design. Prospective longitudinal study. Setting. A University Hospital. Patients. Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months post-injury. Main Outcome Measures. Basal and dynamic tests of pituitary function were performed in all patients and growth hormone (GH) dynamic testing was repeated in patients with low stimulated GH peak (< 7 ng/ml). The diagnosis of proven severe GH deficiency (GHD) was based on the association of two GH peaks <5 ng/ml on both occasion of testing and IGF-1 levels below -2 SDS. Initial computed tomography (CT) or magnetic resonance imaging (MRI) were analyzed retrospectively. <br><br>RESULTS. We studied 87 children and adolescents (60 males, median age of 6.7 years [range: 0.8-15.2]) 9.5±3.4 months post-TBI (73 accidental, 14 inflicted). The second GH peak, assessed 4.9±0.1 months after the first evaluation, remained low in 27 children and adolescents. Fifteen patients had GH peak <5 ng/ml (mean IGF-1 SDS -1.3±1.5) and five (5.7%) strict criteria for severe GHD. Two children had mild central hypothyroidism and one had ACTH deficiency. We did not find any predictive factors associated with existence of GHD (demographic characteristics, growth velocity, trauma severity and radiological parameters). <br><br>CONCLUSION: At one year post-severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after severe TBI and prolonged clinical endocrine follow-up.<p />  <p>Language: en</p>
LA  - en
SN  - 0021-972X
UR  - http://dx.doi.org/10.1210/jc.2013-4129
ID  - ref1
ER  -