Background: Hypopituitarism is an important sequela of traumatic brain injury (TBI) in adults. In paediatric practice, however, there are concerns that it may be under-recognised. Symptoms may be mistaken for post-concussion syndrome, which may result in delayed investigation and diagnosis. Furthermore, predictors of post-traumatic hypopituitarism (PTHP) in children have not been consistently identified. As normal pituitary function is required for growth, serial growth monitoring may be used as an indicator of pituitary function. There are no previous data as to whether growth monitoring is undertaken routinely following TBI.
Aim: To evaluate whether i) growth monitoring occurred at outpatient review following TBI and ii) evidence of growth failure was related to markers of injury severity.
Methods: Children with TBI discharged from the regional paediatric intensive care unit (PICU) from 1999 to 2004 were identified. Documentation of growth data at outpatient clinic attendances was collected, and SDS calculated using UK 1990 reference data. Clinical markers of TBI severity (Glasgow coma scale (GCS), duration of PICU admission, use of inotropes, invasive intracranial monitoring) were recorded. Children aged <1 year at injury were excluded.
Results: About 123 patients were included in the study (M:F 2.3:1, median age at TBI 10.8 years). Only 33% of follow-up outpatient attendances had documented height and weight measurements. Twenty-two patients (17%) had serial growth measurements, which showed a significant reduction in height SDS (0.17±0.33, P=0.017) over a median follow-up period of 1.6 years. There was a greater reduction in height SDS in children requiring inotropic support (n=9) compared with children who were managed without inotropes (n=13) (0.37±0.35 vs 0.03±0.26, P=0.043). No relationship was identified between the change in height SDS and duration of PICU admission or GCS.
Conclusion: Growth monitoring following TBI was poorly performed in this cohort. The need for inotropic support should be considered in future studies into the predictors of PTHP. Following moderate to severe TBI, an inter-departmental strategy to promote growth monitoring may be required.
05 - 07 Nov 2008
British Society for Paediatric Endocrinology and Diabetes