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Case Reports
. 2023 Jan 6;13(2):212.
doi: 10.3390/diagnostics13020212.

An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges

Raluca Maria Vlad  1   2 , Alice Ioana Albu  3   4 , Irina Delia Nicolaescu  5 , Ruxandra Dobritoiu  1 , Mara Carsote  3   6 , Florica Sandru  7   8 , Dragos Albu  9 , Daniela Păcurar  1   2
Affiliations
Case Reports

An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges

Raluca Maria Vlad et al. Diagnostics (Basel). .

Abstract

Traumatic brain injury (TBI)-related hypopituitarism is a rare polymorphic complication of brain injury, with very little data, particularly concerning children and teenagers. This is a comprehensive review of the literature regarding this pathology, starting from a new pediatric case. The research was conducted on PubMed and included publications from the last 22 years. We identified nine original studies on the pediatric population (two case reports and seven studies; only four of these seven were prospective studies). TBI-related hypopituitarism is associated with isolated hormonal deficits ranging from 22.5% to 86% and multiple hormonal deficiencies from 5.9% to 50% in the studied pediatric population. Growth hormone (GH) deficiency is most often found, including the form with late occurrence after TBI; it was described as persistent in half of the studies. Thyroid-stimulating hormone (TSH) deficiency is identified as a distant complication following TBI; in all three studies, we identified this complication was found to be permanent. Adrenocorticotropic hormone (ACTH) deficiency did not relate to a certain type of brain trauma, and it was transient in reported cases. Hyperprolactinemia was the most frequent hormonal finding, also occurring late after injury. Central diabetes insipidus was encountered early post-TBI, typically with a transient pattern and did not relate to a particular type of injury. TBI-related hypopituitarism, although rare in children, should be taken into consideration even after a long time since the trauma. A multidisciplinary approach is needed if the patient is to safely overcome any acute condition.

Keywords: ACTH; TSH; delayed puberty; growth hormone deficiency; height; hypopituitarism; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
This is a 17-year-old male patient admitted for evaluation of TBI 4 years after a severe car accident. Clinical findings: coarse features, round face, absence of face and axillary hair, delayed puberty.
Figure 2
Figure 2
Magnetic resonance imaging on a 17-year-old male with post-brain trauma injury, 4 years after a severe car accident.
Figure 2
Figure 2
Magnetic resonance imaging on a 17-year-old male with post-brain trauma injury, 4 years after a severe car accident.
See this image and copyright information in PMC

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