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Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury.

Reifschneider K, Auble BA, Rose SR - J Clin Med (2015)

Bottom Line: Traumatic brain injuries (TBI) are common occurrences in childhood, often resulting in long term, life altering consequences.In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children's quality of life both acutely and chronically.Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of The Kings Daughters, Eastern Virginia Medical School, Norfolk, Virginia, VA 23507, USA. Kent.Reifschneider@chkd.org.

ABSTRACT
Traumatic brain injuries (TBI) are common occurrences in childhood, often resulting in long term, life altering consequences. Research into endocrine sequelae following injury has gained attention; however, there are few studies in children. This paper reviews the pathophysiology and current literature documenting risk for endocrine dysfunction in children suffering from TBI. Primary injury following TBI often results in disruption of the hypothalamic-pituitary-adrenal axis and antidiuretic hormone production and release, with implications for both acute management and survival. Secondary injuries, occurring hours to weeks after TBI, result in both temporary and permanent alterations in pituitary function. At five years after moderate to severe TBI, nearly 30% of children suffer from hypopituitarism. Growth hormone deficiency and disturbances in puberty are the most common; however, any part of the hypothalamic-pituitary axis can be affected. In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children's quality of life both acutely and chronically. Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances. High indices of suspicion for life threatening endocrine deficiencies should be maintained during acute care. Additionally, survivors of TBI should undergo endocrine surveillance by 6-12 months after injury, and then yearly, to ensure early detection of deficiencies in hormonal production that can substantially influence growth, puberty and quality of life.

No MeSH data available.


Related in: MedlinePlus

Hypothesized model for progression from Primary to Secondary Injury after trauma to the central nervous system.
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jcm-04-01536-f001: Hypothesized model for progression from Primary to Secondary Injury after trauma to the central nervous system.

Mentions: Traumatic brain injury is described as a non-congenital insult to the brain from an external mechanical force causing temporary or permanent neurological dysfunction. TBI is classified as focal due to direct physical impact to the brain (penetrating or contusion), or diffuse following rapidly changing forces. The initial injury or mechanism can include penetrating, tearing, shearing, and/or hemorrhage. Initial physiologic response to TBI, or “primary injury”, involves decrease in cerebral flow leading to decreased protein synthesis and acidosis. Increases in free radical and cation production alter the electro-potential gradient, causing fluid shifts and resulting in swelling and apoptosis (Figure 1).


Update of Endocrine Dysfunction following Pediatric Traumatic Brain Injury.

Reifschneider K, Auble BA, Rose SR - J Clin Med (2015)

Hypothesized model for progression from Primary to Secondary Injury after trauma to the central nervous system.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555075&req=5

jcm-04-01536-f001: Hypothesized model for progression from Primary to Secondary Injury after trauma to the central nervous system.
Mentions: Traumatic brain injury is described as a non-congenital insult to the brain from an external mechanical force causing temporary or permanent neurological dysfunction. TBI is classified as focal due to direct physical impact to the brain (penetrating or contusion), or diffuse following rapidly changing forces. The initial injury or mechanism can include penetrating, tearing, shearing, and/or hemorrhage. Initial physiologic response to TBI, or “primary injury”, involves decrease in cerebral flow leading to decreased protein synthesis and acidosis. Increases in free radical and cation production alter the electro-potential gradient, causing fluid shifts and resulting in swelling and apoptosis (Figure 1).

Bottom Line: Traumatic brain injuries (TBI) are common occurrences in childhood, often resulting in long term, life altering consequences.In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children's quality of life both acutely and chronically.Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances.

View Article: PubMed Central - PubMed

Affiliation: Children's Hospital of The Kings Daughters, Eastern Virginia Medical School, Norfolk, Virginia, VA 23507, USA. Kent.Reifschneider@chkd.org.

ABSTRACT
Traumatic brain injuries (TBI) are common occurrences in childhood, often resulting in long term, life altering consequences. Research into endocrine sequelae following injury has gained attention; however, there are few studies in children. This paper reviews the pathophysiology and current literature documenting risk for endocrine dysfunction in children suffering from TBI. Primary injury following TBI often results in disruption of the hypothalamic-pituitary-adrenal axis and antidiuretic hormone production and release, with implications for both acute management and survival. Secondary injuries, occurring hours to weeks after TBI, result in both temporary and permanent alterations in pituitary function. At five years after moderate to severe TBI, nearly 30% of children suffer from hypopituitarism. Growth hormone deficiency and disturbances in puberty are the most common; however, any part of the hypothalamic-pituitary axis can be affected. In addition, endocrine abnormalities can improve or worsen with time, having a significant impact on children's quality of life both acutely and chronically. Since primary and secondary injuries from TBI commonly result in transient or permanent hypopituitarism, we conclude that survivors should undergo serial screening for possible endocrine disturbances. High indices of suspicion for life threatening endocrine deficiencies should be maintained during acute care. Additionally, survivors of TBI should undergo endocrine surveillance by 6-12 months after injury, and then yearly, to ensure early detection of deficiencies in hormonal production that can substantially influence growth, puberty and quality of life.

No MeSH data available.


Related in: MedlinePlus