Anterior Pituitary Dysfunction and Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. Subsequent endocrine changes have been illustrated in adults and have been recently investigated in children as well. Head injury occurs often in children, and TBI has accounted for many emergency department visits. The most common type of brain injury in children is diffuse brain injury caused by acceleration or deceleration forces. In adults, there is no relationship that has emerged between the occurrence of pituitary dysfunction and time after TBI, type or severity of initial injury, or later outcome. In pediatrics, studies have shown that a delay in diagnosing pituitary dysfunction was common. In children with TBI, a screening algorithm, starting with measurement of an early-morning cortisol, should be followed to identify pituitary dysfunction in a timely fashion and initiate treatment promptly when necessary.