Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolescents: a large prospective study.
Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolescents: a large prospective study.
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儿童和青少年严重创伤性脑损伤后垂体功能障碍的患病率：一项大型前瞻性研究。
DOI：
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发表时间：
2014
影响因子：
5.8
通讯作者：
M. Polak
中科院分区：
文献类型：
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作者：
Claire Personnier;H. Crosnier;P. Meyer;M. Chevignard;I. Flechtner;N. Boddaert;S. Breton;Caroline Mignot;Yamina Dassa;J. Souberbielle;M. Piketty;K. Laborde;J. Jais;M. Viaud;S. Puget;C. Sainte‐Rose;M. Polak
上下文
儿童创伤性脑损伤（TBI）是一个重大的公共卫生问题。
目的
我们试图确定儿童和青少年严重TBI后垂体功能障碍的患病率，并确定任何潜在的预测因素。
设计
这是一项前瞻性纵向研究。
设置
这项研究是在一所大学医院进行的。
患者
包括因严重意外或创伤性脑损伤住院的患者。在损伤后6至18个月进行内分泌评估。
主要观察指标
所有患者均行垂体功能基础及动态检测，GH刺激峰值低（<7 ng/mL）者行GH动态检测。经证实的重度GH缺乏症（GHD）的诊断是基于两次检测时两个GH峰值均小于5 ng/mL和IGF-I水平低于-2 SD评分的相关性。回顾性分析了最初的头颅断层扫描或磁共振成像。
结果
我们研究了87名儿童和青少年[60名男性，中位年龄6.7岁（范围0.8-15.2）] TBI后9.5 ± 3.4个月（73名意外，14名受伤）。第二个GH峰值在第一次评估后4.9 ± 0.1个月评估，在27名儿童和青少年中保持较低水平。15例患者的GH峰值小于5 ng/mL（平均IGF-I SD评分为-1.3 ± 1.5），5例（5.7%）符合重度GHD的严格标准。两名儿童有轻度中枢性甲状腺功能减退症，一名儿童有ACTH缺乏症。我们没有发现任何与GHD存在相关的预测因素（人口统计学特征、生长速度、创伤严重程度和放射学参数）。
结论
在严重TBI后1年，我们的研究样本中有8%发现垂体功能障碍。我们建议儿童和青少年在严重TBI后12个月进行系统的激素评估，并延长临床内分泌随访。
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.