Mild traumatic brain injury and immediate hypopituitarism in children

David Gonçalves Nordon, Rodrigo Rejtman Guimarães, Alcinda Aranha Nigri, Sandro Blasi Esposito

Abstract


AIMS: Traumatic brain injury is a common and costly trauma that may lead to hypopituitarism. Its complications may have great impact on public health, especially in children. This study evaluates the prevalence of immediate hypopituitarism in children who suffered mild traumatic brain injury.
METHODS: Children who were admitted in the emergency service of Unidade Regional de Emergência – Conjunto Hospitalar de Sorocaba due to traumatic brain injury were evaluated for the study. Every patient underwent a head computed tomography at admittance and was classified according to the Glasgow Coma Scale, being traumatic brain injury graded in severe (<9), moderate (9-12) or mild (>12). Those whose parents or guardians agreed to participate and presented mild trauma were included in the study and invited to perform a neuroendocrinological evaluation.
RESULTS: Sixty-eight children were admitted with traumatic brain injury, and 21 agreed to participate. Five patients did not perform the urine and blood exams, two had a moderate TBI, and one had a severe TBI, and therefore were excluded from data analysis. Among the 13 patients whose exams were performed in less than 48 hours from the trauma, five (38.5%) presented hormonal alterations, respectively: single thyroid-stimulant hormone (TSH) elevation, single insuline-like growth factor 1 (IGF-1) elevation, single cortisol elevation, combined folicule-stimulant hormone (FSH) and prolactin elevation, and combined TSH and FSH elevation. None presented symptoms of hypopituitarism. There was no association between head image alterations and hypopituitarism.
CONCLUSIONS: The results found in this study lead to probably little significant endocrine dysfunctions, as such hormonal increases may be related to acute trauma response. Considering the literature and the results, it is possible to speculate that the relationship of traumatic brain injury with hypopituitarism in children is different from adults.
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Keywords


CRANIOCEREBRAL TRAUMA; BRAIN INJURIES; HEAD INJURIES; THYROID GLAND; HYPOPITUITARISM; CHILD; EMERGENCY MEDICINE.



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