Pituitary function at long-term follow up of childhood traumatic brain injury

Pituitary dysfunction is a recognised sequel of traumatic brain injury (TBI), occurring in 10-83% of adult patients, but there are few data on the prevalence or natural history in childhood. Our objective was to determine pituitary function in children and young adults at least 4 years after TBI requiring paediatric intensive care unit (PICU) admission. The effects of TBI and hypopituitarism on height, adiposity and quality of life (QOL) were also evaluated. Unselected patients discharged from the regional PICU with TBI (age <18years at injury) from 1999-2004 were recruited. Blood and urine samples were collected for baseline pituitary function testing. Height and weight were measured. Adiposity was assessed by mid-upper arm and waist circumferences and body fat percentage estimation using four-site skinfold thickness and bioelectrical impedance. Auxology and adiposity data were compared to local age and sex matched healthy control data. QOL questionnaires (PedsQL 4.0 and QOL-AGHDA) were completed. Twenty subjects (median age 16.7 years (range 9.2 - 23.3 years), 13 male) of 127 eligible agreed to participate at a median of 6.8 years (range 4.2 - 10.3 years) since TBI; markers of injury were higher in those recruited than those who were not. Biochemical evidence of hypopituitarism was identified in only one case, possibly related to co-morbid pre-existing attention deficit hyperactivity disorder. Height, weight and adiposity were similar to healthy controls. Poor QOL was seen in patients with chronic functional deficits or co-morbidities. Overall, pituitary dysfunction was less prevalent than previous studies in adults and children. This study does not support the use of routine endocrine evaluation of children following TBI