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Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol

  • Nadvadee Aungkawattanapong ORCID logo , Ketsuda Jakchai ORCID logo , Therdpong Tempark ORCID logo and Chansuda Bongsebandhu-phubhakdi ORCID logo EMAIL logo
Published/Copyright: July 21, 2022
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 8

Abstract

Objectives

Post-traumatic brain injury hypopituitarism is a common unrecognized condition in children after head injury. Due to its similarity of clinical symptoms with those of head trauma, clinical diagnosis of post-TBI hypopituitarism is challenging. To date, there is no standardized screening protocol for children with history of brain injury. This article demonstrates a case of 14-year-old boy with severe head trauma who developed refractory seizures with episodic hypoglycemia and weight loss. We aimed to focus on the prevalence, clinical courses and clinical implementations of each hormonal axis in children with post-traumatic brain injury hypopituitarism. We also aim to raise awareness of this condition to pediatricians in light of enhancing patient care.

Methods

We have searched for original articles, published in English between year 2000 and 2021. There are 20 related articles, authors reviewed all the articles independently.

Results

Prevalence of post-traumatic hypopituitarism ranges from 5–57% in children. Growth hormone is the most commonly affected hormone. The highest prevalence is 42.3% at more than 12 months after the brain injury. The symptoms and severity range from asymptomatic to requiring long-term hormonal therapy. Although normalization of pituitary function is demonstrated at various times after the injury, hormone replacement therapy is still required in some patients.

Conclusions

This is the first report that demonstrates a presenting symptom of hypopituitarism mimic traumatic brain symptoms which result in it being overlooked. This case emphasizes the need to develop pituitary function screening protocols for children with TBI. We have proposed our pituitary screening protocol for children with TBI in this article.

Keywords: hypoglycemic seizure; hypopituitarism; traumatic brain injury
Corresponding author: Chansuda Bongsebandhu-phubhakdi, MD, Assistant professor, Division of Ambulatory and Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama IV Road, Pathumwan, 10330 Bangkok, Thailand, E-mail:

Acknowledgments

The authors would like to thank Dr.Papit Suwanpratheep, pediatric neurologist, Ratchaburi Hospital, for providing best initial care for the patient and referring this interesting case to our hospital. We would also like to thank Dr.Patcharin Prateepratana (Patcharin Rolfsen), research affair, Faculty of Medicine, Chulalongkorn University, for kindly reviewing and editing our English article.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. NA interpreted the data, conceived and designed the study, conducted the work and drafted and revised the article; KJ conceived and designed the study, conducted the work and revised the article; TT conceived and designed the study, conducted the work and revised the article; CB conceived and designed the study, conducted the work and revised the article.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Not applicable.

References

1. Dewan, MC, Rattani, A, Gupta, S, Baticulon, RE, Hung, YC, Punchak, M, et al.. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018;130:1–18.10.3171/2017.10.JNS17352Search in Google Scholar PubMed

2. Casano-Sancho, P. Pituitary dysfunction after traumatic brain injury: are there definitive data in children? Arch Dis Child 2017;102:572–7. https://doi.org/10.1136/archdischild-2016-311609.Search in Google Scholar PubMed

3. Schneider, HJ, Kreitschmann-Andermahr, I, Ghigo, E, Stalla, GK, Agha, A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA 2007;298:1429–38. https://doi.org/10.1001/jama.298.12.1429.Search in Google Scholar PubMed

4. Gilis-Januszewska, A, Kluczynski, L, Hubalewski-Dydejczyk, A. Traumatic brian injuries indiced pituitary dysfunction: a call for algorithms. Endocr Connect 2020;9:R112–23. https://doi.org/10.1530/ec-20-0117.Search in Google Scholar

5. Dusick, JR, Wang, C, Cohan, P, Swerdloff, R, Kelly, DF. Pathophysiology of hypopituitarism in the setting of brain injury. Pituitary 2012;15:2–9. https://doi.org/10.1007/s11102-008-0130-6.Search in Google Scholar PubMed PubMed Central

6. Osterstock, G, Yandouzi, TE, Romano, N, Carmignac, D, Langlet, F, Coutry, N, et al.. Sustained alterations of hypothalamic tanycytes during posttraumatic hypopituiraism in male mice. Endocrinol 2014;155:1887–98. https://doi.org/10.1210/en.2013-1336.Search in Google Scholar PubMed

7. Vijapur, SM, Yang, Z, Barton, DJ, Vaughan, L, Awan, N, Kumar, RG, et al.. Anti-pituitary and anti-hypothalamus autoantibody associations with inflammation and persistent hypogonadotropic hypogonadism in men with traumatic brain injury. J Neurotrauma 2020;37:1609–26. https://doi.org/10.1089/neu.2019.6780.Search in Google Scholar PubMed PubMed Central

8. Tanriverdi, F, Taheri, S, Ulutabanca, H, Caglayan, AO, Ozkul, Y, Dundar, M, et al.. Apolipoprotein E3/E3 genotype decreases the risk of pituitary dysfunction after traumatic brain injury due to various causes: preliminary data. J Neurotrauma 2008;25:1071–7. https://doi.org/10.1089/neu.2007.0456.Search in Google Scholar PubMed

9. Bellone, S, Einaudi, S, Caputo, M, Prodam, F, Busti, A, Belcastro, S, et al.. Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury. Pituitary 2013;16:499–506. https://doi.org/10.1007/s11102-012-0446-0.Search in Google Scholar PubMed

10. Einaudi, S, Matarazzo, P, Peretta, P, Grossetti, R, Giordano, F, Altare, F, et al.. Hypothalamo-hypophyial dysfunction after traumatic brain injury in children and adolescents: a preliminary retrospective and prospective study. J Pediatr Endocrinol Metab 2006;19:691–703.10.1515/JPEM.2006.19.5.691Search in Google Scholar

11. Poomthavorn, P, Maixner, W, Zacharin, M. Pituitary function in paedeatric survivors of severe traumatic brain injury. Arch Dis Child 2008;93:133–7. https://doi.org/10.1136/adc.2007.121137.Search in Google Scholar PubMed

12. Casano-Sancho, P, Suarez, L, Ibanez, L, Garcia-Fructuoso, G, Medina, J, Febrer, A. Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment? Clin Endocrinol 2013;79:853–8. https://doi.org/10.1111/cen.12237.Search in Google Scholar PubMed

13. Krahulik, D, Aleksijevic, D, Smolka, V, Klaskova, E, Venhacova, P, Vaverka, M, et al.. Prospectice study of hypothalamo-hypophyseal dysfunction in children and adolescents following traumatic brain injury. Biomed Pap Med Fac Univ Palacky Olonouc Czech repub 2017;161:80–5. https://doi.org/10.5507/bp.2016.047.Search in Google Scholar PubMed

14. Salomon-Estebanez, MA, Grau, G, Vela, A, Rodriguez, A, Morteruel, E, Castano, L, et al.. Is routine endocrine evaluation necessary after paediatric traumatic brain injury? J Endocrinol Invest 2014;37:143–8. https://doi.org/10.1007/s40618-013-0020-2.Search in Google Scholar PubMed

15. Casano-Sancho, P, Suarez, L, Ibanez, L, Garcia-Fructuoso, G, Medina, J, Febrer, A. Pituitary dysfunction after traumatic brain injury in children: is there a need for ongoing endocrine assessment? Clin Endocrinol (Oxf) 2013;79:853–8. https://doi.org/10.1111/cen.12237.Search in Google Scholar

16. Personnier, C, Crosnier, H, Meyer, P, Chevignard, M, Flechtner, I, Boddaert, N, et al.. Prevalence of pituitary dysfunction after severe traumatic brain injury in children and adolscents: a large prospective study. J Clin Endocrinol Metab 2014;99:2052–60. https://doi.org/10.1210/jc.2013-4129.Search in Google Scholar PubMed

17. Dassa, Y, Crosnier, H, Chevignard, M, Viaud, M, Personnier, C, Flechtner, I, et al.. Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study. Eur J Endocrinol 2019;180:281–90. https://doi.org/10.1530/eje-19-0034.Search in Google Scholar

18. Benvenga, S, Vigo, T, Ruggeri, RM, Lapa, D, Almoto, B, LoGiudice, F, et al.. Severe head trauma in patients with unexplained central hypothyroidism. Am J Med 2004;116:767–71. https://doi.org/10.1016/j.amjmed.2003.12.038.Search in Google Scholar PubMed

19. Niederland, T, Makovi, H, Gal, V, Andreka, B, Abraham, CS, Kovacs, J. Abnormalities of pituitary function after traumatic brain injury in children. J Neurotrauma 2007;24:119–27. https://doi.org/10.1089/neu.2005.369er.Search in Google Scholar

20. Khadr, SN, Crofton, PM, Jones, PA, Wardhaught, B, Roach, J, Drake, AJ, et al.. Evaluation of pituitary function after traumatic brain injury in childhood. Clin Endocrinol (Oxf) 2010;73:637–44. https://doi.org/10.1111/j.1365-2265.2010.03857.x.Search in Google Scholar PubMed

21. Heather, NL, Jefferies, C, Hofman, PL, Derraik, JGB, Brennan, C, Kelly, P, et al.. Permanent hypopituitarism is rare after structural traumatic brain injury in early childhood. J Clin Endocrinol Metab 2012;97:599–604. https://doi.org/10.1210/jc.2011-2284.Search in Google Scholar PubMed

22. Moon, RJ, Sutton, T, Wilson, PM, Kirkham, FJ, Davies, JH. Pituitary function at long term follow-up of childhood traumatic brain injury. J Neurotrauma 2010;27:1827–35. https://doi.org/10.1089/neu.2010.1408.Search in Google Scholar PubMed

23. Kgosidialwa, O, Agha, A. Hypopituitarism post traumatic brain injury (TBI): review. Ir J Med Sci 2019;188:1201–6. https://doi.org/10.1007/s11845-019-02007-6.Search in Google Scholar PubMed

24. Tan, CL, Alavi, SA, Baldeweg, SE, Belli, A, Carson, A, Feeney, C, et al.. The screening and management of pituitary dysfunction following traumatic brain injury in adults: British neurotrauma group guidance. J Neurol Neurosurg Psychiatry 2017;88:971–81. https://doi.org/10.1136/jnnp-2016-315500.Search in Google Scholar PubMed PubMed Central

25. Bensalah, M, Donaldson, M, Labassen, M, Cherfi, L, Nebba, M, Haffaf, EM, et al.. Prevalence of hypopituitarism and quality of life in survivors of post-traumatic brain injury. Endocrinol Diab Metab 2020;3. https://doi.org/10.1002/edm2.146.Search in Google Scholar PubMed PubMed Central

26. Ulutabanca, H, Hatipoglu, N, Tanriverdi, F, Gokoglu, A, Keskin, M, Selcuklu, A, et al.. Prospective investigation of anterior pituitary function in the acute phase and 12 months after pediatric traumatic brain injury. Childs Nerv Syst 2014;30:1021–8. https://doi.org/10.1007/s00381-013-2334-y.Search in Google Scholar PubMed

27. Auble, BA, Bollepalli, S, Makoroff, K, Weis, T, Khoury, J, Colliers, T, et al.. Hypopituitarism in pediatric survivors of inflicted traumatic brain injury. J Neurotrauma 2014;31:321–6. https://doi.org/10.1089/neu.2013.2916.Search in Google Scholar PubMed PubMed Central

28. Norwood, KW, Deboer, MD, Gurka, MJ, Kuperminc, MN, Rogol, AD, Blackman, JA, et al.. Traumatic brain injury in children and adolescents: surveillance for pituitary dysfunction. Clin Pediatr 2010;49:1044–9. https://doi.org/10.1177/0009922810376234.Search in Google Scholar PubMed PubMed Central

29. Hannon, MJ, Crowley, RK, Behan, LA, O’Sullivan, EP, O’Brien, MM, Sherlock, M, et al.. Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality. J Clin Endocrinol Metab 2013;98:3229–37. https://doi.org/10.1210/jc.2013-1555.Search in Google Scholar PubMed

30. Briet, C, Braun, K, Lefranc, M, Toussaint, P, Boudailliez, B, Bony, H. Should we assess pituitary function in children after a mild traumatic brain injury? A prospective study. Front Endocrinol 2019;10. https://doi.org/10.3389/fendo.2019.00149.Search in Google Scholar PubMed PubMed Central

31. Srinivas, R, Brown, SD, Chang, YF, Garcia-Fillion, P, Adelson, PD. Endocrine function in children acutely following severe traumatic brain injury. Childs Nerv Syst 2010;26:647–53. https://doi.org/10.1007/s00381-009-1038-9.Search in Google Scholar PubMed

32. Rose, SR, Auble, BA. Endocrine changes after pediatric traumatic brain injury. Pituitary 2012;15:267–75. https://doi.org/10.1007/s11102-011-0360-x.Search in Google Scholar PubMed

33. Klose, M, Juul, A, Struck, J, Morgenthaler, NG, Kosteljanetz, M, Feldt-Rasmussen, U. Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study. Clin Endocrinol (Oxf) 2007;67:598–606. https://doi.org/10.1111/j.1365-2265.2007.02931.x.Search in Google Scholar PubMed

34. Bondanelli, M, Marinis, LD, Ambrosio, MR, Monesi, M, Valle, D, Zatelli, MC, et al.. Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 2004;21:685–96. https://doi.org/10.1089/0897715041269713.Search in Google Scholar PubMed

35. Schneider, M, Schneider, HJ, Yassouridis, A, Saller, B, von Rosen, F, Stalla, GK. Predictors of anterior pituitary insufficiency after traumatic brain injury. Clin Endocrinol (Oxf) 2008;68:206–12.10.1111/j.1365-2265.2007.03020.xSearch in Google Scholar PubMed

36. Ghigo, E, Masel, B, Aimaretti, G, Leon-Carrion, J, Casanueva, FF, Dominguez-Morales, MR, et al.. Consensus guidelines on screening for hypopituitarism following traumatic brain injury. Brain Inj 2005;19:711–24. https://doi.org/10.1080/02699050400025315.Search in Google Scholar PubMed

37. Ghaffar, A, McGowan, B, Tharakan, G, Narayan, N, Cox, R, Hatfield, E, et al.. Unmasking of diabetes insipidus with steroid treatment. Pituitary 2008;15:227.Search in Google Scholar
Received: 2022-01-09
Accepted: 2022-06-18
Published Online: 2022-07-21
Published in Print: 2022-08-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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  16. Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol
  17. Evaluation of the etiological and clinical characteristics of pediatric central diabetes insipidus
  18. Case Reports
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https://doi.org/10.1515/jpem-2022-0129
Keywords for this article
hypoglycemic seizure; hypopituitarism; traumatic brain injury

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Effects of vitamin D supplementation on glycemic control of children and adolescents with type 1 diabetes mellitus: a systematic review
  4. Original Articles
  5. A preliminary study on the relationship between environmental endocrine disruptors and precocious puberty in girls
  6. Tissue concentration of aldosterone in fetal adrenals of intrauterine death cases
  7. Complications of orthopedic treatment in patients diagnosed with X-linked hypophosphatemic rickets
  8. Comparison of insulin sensitivity indices for detection of double diabetes in Indian adolescents with type 1 diabetes
  9. Evaluation of the growth and nutritional status of preschool children: a pilot study in the cold area of China
  10. Arterial hypertension is associated with an increased risk of metabolic complications in pediatric patient with obesity
  11. From pregnancy to breastfeeding: adequate maternal body mass index is essential to prevent a high body mass index in your children
  12. Screening of non-syndromic early-onset child and adolescent obese patients in terms of LEP, LEPR, MC4R and POMC gene variants by next-generation sequencing
  13. The association between vitamin B12, folate, homocysteine levels, and carotid intima-media thickness in children with obesity: a cross-sectional study
  14. Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study
  15. Visceral adiposity is related to insulin sensitivity and inflammation in adolescents with obesity and mild sleep disordered breathing
  16. Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol
  17. Evaluation of the etiological and clinical characteristics of pediatric central diabetes insipidus
  18. Case Reports
  19. Clinical and radiologic evaluation of a Turkish family with hypochondroplasia and a rare FGFR3 variant
  20. Rituximab therapy in ROHHAD(NET) syndrome
  21. Ectopic parathyroid hormone as a rare aetiology of hypercalcemia with rhabdomyosarcoma: a new treatment strategy with zoledronic acid and Denosumab
  22. A 2-bp deletion mutation in SMPD1 gene leading to lysosomal acid sphingomyelinase deficiency in a Chinese consanguineous pedigree
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