Neuro-endocrine Dysfunction in Children and Adolescents after Brain Injury

Czech version

Authors: D. Aleksijević ¹; J. Zapletalová ¹; V. Smolka ¹; E. Klásková ¹; J. Wiedermann ¹; D. Krahulík ²; J. Vaverka ²; Z. Fryšák ³
Authors‘ workplace: LF UP a FN Olomouc Dětská klinika ¹; LF UP a FN Olomouc Neurochirurgická klinika ²; LF UP a FN Olomouc III. interní klinika ³
Published in: Cesk Slov Neurol N 2010; 73/106(4): 409-414
Category: Short Communication

Overview

Background:
Neuro-endocrine dysfunction after traumatic brain injury is found in 23–60% of adult patients. Objectives: To evaluate growth, pubertal development and endocrine function in children and adolescents after traumatic brain injury. Patients and methods: We evaluated growth, pubertal development and bone age in 30 patients (18 boys) after traumatic brain injury. They underwent standard endocrine tests – thyreotropin, free thyroxin, insulin-like growth factor, prolactin, morning cortisol, gonadotropins, testosterone (in boys) and oestradiol (in girls). Dynamics tests were performed in patients with abnormalities revealed by clinical examination and/or laboratory results. Median patient age at the time of brain trauma was 9.7 (0.4–14.8) years; 75% of patients were prepubertal. Their range of Glasgow Coma Scale (GCS) was 3–12 (11 of these <8). Results: Diabetes insipidus was observed in three patients and syndrome of inappropriate adiuretine hormone secretion in a further three. The period since trauma ranged from 26 to 36 months (median 29 months). We found growth hormone deficiency in two boys (in one of them combined with thyreotropin deficiency and diabetes insipidus; precocious puberty in one girl (8.3 years) and one boy (7 years); and hypogonadotrophic hypogonadism in one adolescent girl masked by taking contraceptives pills. Conclusion: We found neuroendocrine dysfunction in 16.7% of patients. Brain-imaging techniques revealed abnormalities in most of them. We have started a prospective study in a large cohort of patients after traumatic brain injury, evaluating the frequency of hormonal disorder and its relations to the type of head trauma and the course of acute post-traumatic phase, with a view to identifying risk factors that predispose to hormonal disorder.

Key words:
traumatic brain injury – children – post-traumatic hormonal disorder – growth hormone deficiency – precocious puberty – risk factors

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