Endocrine Abstracts

Introduction: Post-traumatic hypopituitarism (PTHP) is a recognised sequel of traumatic brain injury (TBI), occurring in 25–69% of adult patients, but there are few data on the prevalence or natural history in childhood. Our aim was to determine pituitary function in children at least 4 years after TBI requiring paediatric intensive care unit (PICU) admission. At the same time body composition was evaluated.

Methods: Children discharged from the regional PICU with TBI from 1999 to 2004 (n=127) were recruited. Clinical markers of TBI severity were obtained from case notes. Height, weight, waist circumference, and body fat percentage by skinfold thickness (SFT) and bioelectrical impedance (BIA) were measured. Blood and urine samples were collected for baseline pituitary function testing. Body composition was compared to age and sex matched controls.

Results: Eighteen patients (mean age 16.5±3.8y, 16 independently mobile) agreed to participate. Age at injury (10.0±4.4y) and gender (67% male) were similar to the whole cohort. Participants had longer duration of PICU admission (8.6±5.5d vs 4.9±6.1d, P=0.001) and inotropic support (4.6±3.1d vs 1.5±4.6d, P<0.001) and lower GCS on arrival (7±3 vs 10±4, P=0.005). Mean interval from injury to assessment was 6.5±1.6y. Standard deviation scores for height (−0.21±1.16), weight (0.21±1.22) and BMI (0.35±1.31) and body fat percentage (SFT 24.2±7.1%; BIA 21.1±7.7%) were not significantly different from controls. Mean difference from mid-parental height SDS was 0.02±0.80. Biochemical evidence of hypopituitarism was identified in only one case but this may have been caused by other confounding factors.

Conclusion: Pituitary dysfunction was less prevalent than published studies, despite the recruited patients having more severe injuries. However, as the time from injury to endocrine assessment was longer than previous reports, recovery of early pituitary dysfunction might have occurred.