Endocrine Abstracts

Background: A recent case of a seven-year-old boy developing diabetes insipidus, central hypothyroidism and growth hormone deficiency following a severe traumatic brain injury (TBI) highlighted a lack of surveillance for post-TBI pituitary dysfunction within the tertiary paediatric hospital of Northern Ireland. There are limited paediatric studies into this area, but evidence suggests post-TBI hypopituitarism occurs fairly frequently in children; with prevalence of isolated hormonal deficits 22.5% - 86% and multiple hormonal deficiencies 5.9% -50%. Growth hormone deficiency and disturbances in puberty are the most common in the paediatric population; however, any part of the hypothalamic-pituitary axis can be affected. A NICE Evidence Review in 2023 reported “There is currently no guidance for the screening and detection of hypopituitarism patients with TBI, with significant variation in practice”.

Aim: To determine our current practice of surveillance for endocrine abnormalities occurring following moderate to severe TBI in children and young people in order to develop cross-specialty guidance.

Method: Retrospective data collection over a five year period (November 2018-2023) of all patients diagnosed with moderate-severe TBI in our tertiary centre. All electronic records including laboratory results audited using a proforma for monitoring and development of pituitary dysfunction.

Results: Data from all 13 patients meeting inclusion criteria collected, with an age range of 3-13 years. Two patients were diagnosed with central hypothyroidism. One patient was diagnosed with diabetes insipidus and growth hormone deficiency. No patients have been diagnosed with central cortisol deficiency or pubertal dysfunction thus far. 4/13 have never had thyroid function tests, 9/13 have never had Cortisol screening and 6/13 have never had their growth assessed post TBI.

Conclusion: Monitoring of pituitary function in this patient cohort is sporadic, and often minimal or non-existent despite evidence of the risk of developing hypopituitarism within five years post TBI. We developed a guideline in collaboration with our neuro-disability colleagues for the surveillance of pituitary dysfunction in the acute and rehabilitation phases post moderate-severe TBI based on our clinical audit and literature review. We hope this will facilitate early identification, prompt and appropriate endocrine referral and ultimately timely management of post- TBI pituitary dysfunction.