Mild traumatic brain injury often disrupts normal pituitary function in children

Physician Reviewing Brain Imaging

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Even a mild TBI (known commonly as concussion) can cause physical, neurological, and cognitive deficits during the recovery period, which may impair a person’s ability to engage in everyday activities. When children experience mild TBI, these deficits can pose additional challenges. Because children’s brains are still developing, physical trauma can disrupt the typical course of development and may be associated with long-term negative health outcomes.

Research on pediatric TBI suggests that pituitary deficiency is common in children who have experienced a brain injury. The pituitary gland is a small area of the brain that controls the production and release of many of the body’s hormones. In typically developing children and adolescents, the pituitary gland releases a number of these hormones that are critical for healthy development. When a brain injury disrupts the normal function of the pituitary gland, a child may experience problems with normal growth and sexual development.

Although the negative health outcomes associated with pituitary deficiency are well known, current research is inconsistent in estimating the frequency of this disorder in children with TBI. Some studies have estimated that the frequency is as low as 0.8 percent, while other estimates are as high as 90 percent. To address this wide variation across studies, a team of researchers in France aimed to definitively identify the frequency of pituitary deficiency in children who sustained mild TBI. The researchers collected data from 109 children between the ages of 2 and 16 years who were hospitalized for mild TBI over a four-year period. They monitored the participants’ growth progress over time, assessing the children at six months and twelve months after injury. At each time interval, the research team measured factors related to pituitary deficiency, including height and weight, insulin tolerance, and hormone levels.

They found that 7.2 percent of children exhibited signs of pituitary deficiency one year after injury. Two of the children lacked sufficient levels of human growth hormone (HGH), a deficiency that typically causes short stature and delayed maturation. Although the researchers found a relatively low frequency of pituitary deficiency compared to previous studies, it is critical to consider the potential lifespan impact of hormonal imbalances and deficiencies in children with TBI. As a result, clinicians are advised to assess children and adolescents for pituitary deficiency after TBI to ensure that young patients receive timely, targeted interventions to promote healthy development into adulthood.

Briet C, Braun K, Lefranc M, et al. Should we assess pituitary function in children after a mild traumatic brain injury? A prospective study. Frontiers in Endocrinology. (March 2019).

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