scholarly journals Prevalence of Pituitary Dysfunction After Severe Traumatic Brain Injury in Children and Adolescents: A Large Prospective Study

2014 ◽  
Vol 99 (6) ◽  
pp. 2052-2060 ◽  
Author(s):  
Claire Personnier ◽  
Hélène Crosnier ◽  
Philippe Meyer ◽  
Mathilde Chevignard ◽  
Isabelle Flechtner ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Children And Adolescents ◽  
Predictive Factors ◽  
Public Health Issue ◽  
Prospective Longitudinal Study ◽  
Pituitary Dysfunction ◽  
Igf I ◽  
Severe Tbi ◽  
Prospective Longitudinal

Context: Traumatic brain injury (TBI) in childhood is a major public health issue. 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: This was a prospective longitudinal study. Setting: The study was conducted at a university hospital. Patients: Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months after the injury. Main Outcome Measures: Basal and dynamic tests of pituitary function were performed in all patients and 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 less than 5 ng/mL on both occasions of testing and IGF-I levels below −2 SD score. Initial cranial tomography or magnetic resonance imaging was analyzed retrospectively. Results: We studied 87 children and adolescents [60 males, median age 6.7 y (range 0.8–15.2)] 9.5 ± 3.4 months after the 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 a GH peak less than 5 ng/mL (mean IGF-I SD score −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). Conclusion: At 1 year after the severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after a severe TBI and prolonged clinical endocrine follow-up.

scholarly journals Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

2019 ◽  
Vol 180 (5) ◽  
pp. 281-290 ◽  
Author(s):  
Yamina Dassa ◽  
Hélène Crosnier ◽  
Mathilde Chevignard ◽  
Magali Viaud ◽  
Claire Personnier ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Height Velocity ◽  
Prospective Longitudinal Study ◽  
Pituitary Dysfunction ◽  
Severe Tbi ◽  
Prospective Longitudinal

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3–4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<−1 DS) or low IGF-1 (<−2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5–10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4–6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

Intellectual Outcome from Preschool Traumatic Brain Injury: A 5-Year Prospective, Longitudinal Study

PEDIATRICS ◽  
2009 ◽  
Vol 124 (6) ◽  
pp. e1064-e1071 ◽  
Author(s):  
V. Anderson ◽  
C. Catroppa ◽  
S. Morse ◽  
F. Haritou ◽  
J. V. Rosenfeld
Keyword(s):  
Traumatic Brain Injury ◽  
Longitudinal Study ◽  
Brain Injury ◽  
Prospective Longitudinal Study ◽  
Intellectual Outcome ◽  
Prospective Longitudinal

Is Computerized Cognitive Testing Useful in Children and Adolescents with Moderate-to-Severe Traumatic Brain Injury?

2017 ◽  
Vol 23 (4) ◽  
pp. 304-313 ◽  
Author(s):  
Vickie Plourde ◽  
Brian L. Brooks
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Reaction Time ◽  
Cognitive Functioning ◽  
Children And Adolescents ◽  
Severe Traumatic Brain Injury ◽  
Effect Sizes ◽  
Medium Effect ◽  
Control Group ◽  
Severe Tbi

AbstractObjectives: Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. Methods: Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0.6 month). Participants with TBI were matched to 33 healthy controls based on age, sex, and handedness to compare their cognitive functioning on the CNSVS battery. Results: Children and adolescents with moderate-to-severe TBI had significantly lower scores and large effect sizes on Reaction Time, Complex Attention, and Cognitive Flexibility domains, as well as medium effect sizes on two Visual Memory test scores and one Psychomotor Speed test score. A significantly higher percentage of participants with TBI had cognitive impairment on Reaction Time domain score compared to the control group. Finally, CNSVS domain scores correctly categorized 76% of participants as either group with TBI or control group. Conclusions: CNSVS may be a useful tool for screening cognitive abilities in children and adolescents who are early in their recovery from a moderate-to-severe TBI, particularly when a rapid screening evaluation can help guide management, interventions, and track recovery. (JINS, 2017, 23, 304–313)

scholarly journals Traumatic Brain Injury in Children and Adolescents: Surveillance for Pituitary Dysfunction

2010 ◽  
Vol 49 (11) ◽  
pp. 1044-1049 ◽  
Author(s):  
Kenneth W. Norwood ◽  
Mark D. DeBoer ◽  
Matthew J. Gurka ◽  
Michelle N. Kuperminc ◽  
Alan D. Rogol ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Children And Adolescents ◽  
Pituitary Dysfunction

scholarly journals Longitudinal volumetric MRI study of pituitary gland following severe traumatic brain injury

2012 ◽  
Vol 19 (3) ◽  
pp. 193-202 ◽  
Author(s):  
Sorin C. Craciunas ◽  
Carmen M. Cirstea ◽  
Hung-Wen Yeh ◽  
Lewis Hutfles ◽  
Joann Lierman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pituitary Gland ◽  
Magnetic Resonance Images ◽  
Time Points ◽  
Patient Demographics ◽  
Pituitary Dysfunction ◽  
Mri Morphometry ◽  
Severe Tbi ◽  
Mri Study

Abstract Purpose: Previous studies have suggested that the hypopituitarism following traumatic brain injury (TBI) is more prevalent than traditionally thought. The objective of this study was to characterize longitudinal MRI morphometric changes of pituitary gland in patients with severe TBI. Materials and methods: Fourteen patients who had suffered a severe TBI (Glasgow Coma Score=3 - 8) underwent MRI at three time points: Time 1 (mean=31. 5 days), Time 2 (98. 0) and Time 3 (185. 5). The pituitary gland volume was quantified by manually tracing on T1-weighted magnetic resonance images. Data from TBI patients were compared to 14 age- and sexmatched uninjured controls. The relationships between pituitary volumetric measures and patient demographics, length of respiratory support and coma, and presence of intracranial hemorrhage or skull fractures were also analyzed. Results: Following TBI, the pituitary volumes were significantly greater at all three time points: Time 1: median=665mm3, range=460-830mm3, p=0. 007; Time 2: 694mm3, 467-866mm3, 0. 007; and Time 3: 655mm3, 444- 795mm3, 0. 015, compared with controls (504mm3, 433-591mm3). At Time 1, pituitary volume was increased in 10 out of 14 patients. Of these, early pituitary enlargements persisted up to six months in nine patients. Pituitary enlargements were negatively correlated with GCS, but not with other variables. Conclusion: Following a severe TBI, early pituitary enlargement found in most of our patients persisted in the chronic phases. Our data suggest a potential role of MRI morphometry in early prediction of pituitary dysfunction following head trauma, but further studies including hormonal measurements are necessary for validation.

scholarly journals Prognostic Models of Mortality from Accidental Severe Traumatic Brain Injury in Children and Adolescents: A Systematic Review

2021 ◽  
Vol 3 (3(September-December)) ◽  
Author(s):  
Jose Roberto Tude Melo ◽  
Marcelo Liberato Coelho Mendes de Carvalho
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Children And Adolescents ◽  
Severe Traumatic Brain Injury ◽  
Scientific Evidence ◽  
Prognostic Models ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Severe Tbi

Introduction: Prognostic models are statistical models that combine two or more items of patient data to predict clinical outcomes. Objective: Identify prognostic models of mortality developed and published in the medical literature for possible applicability in children and adolescents victims of severe traumatic brain injury (TBI). Methods: Systematic review in the Medline electronic database (PubMed platform) of scientific articles published from 2006 (year of publication of the last systematic review on prognostic models for TBI before 2017) until July 29, 2017. Results: Ten studies on prognostic models of mortality in children and adolescents victims of severe TBI were identified for final inclusion in the review. There were eight development and two validation studies conducted in different countries. Conclusion: The analysis of this systematic review makes it possible to conclude that the ten prognostic models included in the final sample provide health professionals with a scientific evidence-based understanding of the severity of pediatric victims of severe TBI. This systematic review is classified as presenting 2A and 1 level of evidence (systematic review of homogeneous cohorts), according to the 2009 and 2011 classifications, respectively, of the Oxford Center for Evidence-Based Medicine

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