Measurement of height velocity is an useful marker for monitoring pituitary function in patients who had traumatic brain injury

Pituitary. 2013 Dec;16(4):499-506. doi: 10.1007/s11102-012-0446-0.

Abstract

To assess the incidence of abnormal neuroendocrine function post-traumatic brain injuriy (TBI) in a large group of paediatric patients and its correlations with clinical parameters (Glasgow coma scale-GCS, Glasgow outcome scale-GOS, TC marshall scale, height velocity). We evaluated 70 patients [58 M, 12 F; age at the time of TBI (mean ± SEM) 8.12 ± 4.23 years] previously hospitalized for TBI at the "Regina Margherita" Hospital, in Turin and "Maggiore della Carità Hospital" in Novara, Italy, between 1998 and 2008. All patients included underwent: auxological, clinical, hormonal and biochemical assessments at recall (after at least 1 year from TBI to T0); auxological visit after 6 months (T6) and hormonal assessments at 12 months (T12) in patients with height velocity (HV) below the 25th centile. At T0, 4 cases of hypothalamus-pituitary dysfunction had been diagnosed; At T6 20/70 patients had an HV <25th centile, but no one had HV < the 3rd centile limit. At T12, among the 20 patients with HV <25th centile, in 13 patients the HV was below the 25th centile and GHRH + Arginine test has been performed. Four subjects demonstrated an impaired GH peak and were classified as GH deficiency (GHD). Of these 4 subjects, 3 subjects showed isolated GHD, while one patient showed multiple hypopituitarism presenting also secondary hypocortisolism and hypothyroidism. The GCS at admission and GOS do not correlate with the onset of hypopituitarism. A simple measurement of the height velocity at least 1 year after the TBI, is enough to recognize patients with a pituitary impairment related to GH deficiency. We suggest to follow-up paediatric population who had TBI with auxological evaluations every 6 months, limiting hormonal evaluation in patients with a reduction of height velocity below the 25th centile limit.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Height / physiology*
  • Brain Injuries / metabolism
  • Brain Injuries / pathology
  • Brain Injuries / physiopathology*
  • Child
  • Child, Preschool
  • Female
  • Growth Hormone / deficiency
  • Growth Hormone / metabolism
  • Humans
  • Male
  • Pituitary Gland / metabolism
  • Pituitary Gland / pathology
  • Pituitary Gland / physiopathology*
  • Prospective Studies

Substances

  • Growth Hormone