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Bhat JN, Amato A, Schultz S, Gomez R. Protocol-Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A Quality Improvement Initiative. Clin Pediatr (Phila) 2024:99228241230390. [PMID: 38327253 DOI: 10.1177/00099228241230390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing neuroendocrine dysfunction. As a third of children can develop post-traumatic hypothalamo-pituitary axis dysfunction (HPAD), a longitudinal follow-up is required in children with TBI. METHOD The study comprised a pre-quality improvement (QI) phase (baseline phase) and a QI phase (post-intervention phase). Retrospective data were collected on children with TBI at our hospital during the pre-QI phase of the study to estimate the baseline data on HPAD prevalence and pediatric endocrine referral rate. Guidance protocol for standardizing the pediatric endocrine referral, evaluation, and follow-up of children with TBI was implemented. Prospective data were collected to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and outpatient follow-up) and process measures (protocol adherence rate). RESULT Twenty-seven children, aged ≤19 years, were admitted with TBI in the pre-QI phase. The median age was 9 years. Motor vehicle accidents predominated. Thirty percent had limited endocrine evaluation, and 4% had transient cranial diabetes insipidus (DI). The QI phase included 8 children. Demographic data were similar to those in the pre-QI phase. Both outcome and process measures increased to 75% from the pre-QI phase following the protocol implementation. CONCLUSION A lower prevalence rate of HPAD in the current cohort may be owing to underevaluation and a smaller sample size. The QI initiative incorporating a guidance protocol-based endocrinological approach to children with TBI improved the pediatric endocrinology referral and follow-up rates.
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Affiliation(s)
- Jayalakshmi Narayan Bhat
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, Shreveport, LA, USA
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Abbie Amato
- The Gilda Trautman Newman Rehabilitation Center at Children's Hospital, New Orleans, LA, USA
| | - Scott Schultz
- The Gilda Trautman Newman Rehabilitation Center at Children's Hospital, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA
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Ortiz JB, Tellez S, Rampal G, Mannino GS, Couillard N, Mendez M, Green TRF, Murphy SM, Rowe RK. Diffuse traumatic brain injury substantially alters plasma growth hormone in the juvenile rat. J Endocrinol 2024; 260:e230157. [PMID: 37855319 PMCID: PMC10692649 DOI: 10.1530/joe-23-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Traumatic brain injury (TBI) can damage the hypothalamus and cause improper activation of the growth hormone (GH) axis, leading to growth hormone deficiency (GHD). GHD is one of the most prevalent endocrinopathies following TBI in adults; however, the extent to which GHD affects juveniles remains understudied. We used postnatal day 17 rats (n = 83), which model the late infantile/toddler period, and assessed body weights, GH levels, and number of hypothalamic somatostatin neurons at acute (1, 7 days post injury (DPI)) and chronic (18, 25, 43 DPI) time points. We hypothesized that diffuse TBI would alter circulating GH levels because of damage to the hypothalamus, specifically somatostatin neurons. Data were analyzed with generalized linear and mixed effects models with fixed effects interactions between the injury and time. Despite similar growth rates over time with age, TBI rats weighed less than shams at 18 DPI (postnatal day 35; P = 0.03, standardized effect size [d] = 1.24), which is around the onset of puberty. Compared to shams, GH levels were lower in the TBI group during the acute period (P = 0.196; d = 12.3) but higher in the TBI group during the chronic period (P = 0.10; d = 52.1). Although not statistically significant, TBI-induced differences in GH had large standardized effect sizes, indicating biological significance. The mean number of hypothalamic somatostatin neurons (an inhibitor of GH) positively predicted GH levels in the hypothalamus but did not predict GH levels in the somatosensory cortex. Understanding TBI-induced alterations in the GH axis may identify therapeutic targets to improve the quality of life of pediatric survivors of TBI.
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Affiliation(s)
- J Bryce Ortiz
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Sebastian Tellez
- Arizona State University, School of Life Sciences, Tempe, Arizona, USA
| | - Giri Rampal
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Grant S Mannino
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Nicole Couillard
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Matias Mendez
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Tabitha R F Green
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Sean M Murphy
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Rachel K Rowe
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
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Livny A, Silberg T. Puberty, brain network connectivity and neuropsychiatric outcomes following pediatric traumatic brain injury in females: A research protocol. PLoS One 2023; 18:e0296325. [PMID: 38157340 PMCID: PMC10756517 DOI: 10.1371/journal.pone.0296325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Examining the role of sex on recovery from pediatric TBI (pTBI) is a complex task, specifically when referring to injuries occurring during critical developmental and maturation periods. The effect of sex hormones on neurological and neuropsychiatric outcomes has been studied among adult TBI females, but not in children. During development, puberty is considered a key milestone accompanied by changes in physical growth, neuronal maturation, sex hormones, and psychological symptoms. Following pTBI, such changes might have a significant effect on brain re-organization and on long-term neuropsychiatric outcomes. While hormonal dysfunction is a common consequence following pTBI, only few studies have systematically evaluated hormonal changes following pTBI. AIMS To describe a multimodal protocol aimed to examine the effect of puberty on brain connectivity and long-term neuropsychiatric outcomes following TBI in female girls and adolescents. METHODS A case-control longitudinal prospective design will be used. 120 female participants aged 9 to 16 years (N = 60 per group) will be recruited. In the acute phase (T0-1 month), participants will undergo an MRI protocol for brain connectivity, as well as a clinical evaluation for puberty stage and hormonal levels. In the chronic phase (T1-18-24 months), participants will complete a neuropsychiatric assessment in addition to the MRI and puberty evaluations. Hormonal levels will be monitored at T0 and T1. A moderation-mediation model will be used to examine the moderating effects of puberty on the association between pTBI and neuropsychiatric symptoms in female girls and adolescents, through the mediating effect of brain network connectivity. SIGNIFICANCE This study will highlight sex-specific factors related to outcomes among females following pTBI and enhance our understanding of the unique challenges they face. Such information has a substantial potential to guide future directions for research, policy and practice.
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Affiliation(s)
- Abigail Livny
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel
- Department of imaging, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- Department of Pediatric Rehabilitation, Edmond and Lily Safra, Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
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Abstract
PURPOSE OF REVIEW This article reviews hypopituitarism after TBI, the importance of pituitary hormones, and related controversies, concluding with a suggested patient approach. RECENT FINDINGS While earlier studies focused on increased pituitary deficiencies after moderate-severe TBI, recent studies have focused on deficiencies after mild TBI. There has been increasing focus on the role of growth hormone after injury; growth hormone is the most frequent reported deficiency at 1 year post-TBI, and an area with unresolved questions. While more research is needed to quantify the risk of deficiencies in special populations, and establish the natural history, increasing data indicate an increase in hypopituitarism after other acquired brain injuries; the potential role of pituitary hormone deficiencies after stroke and after COVID-19 infection is an area of active inquiry. Given the negative health effects of untreated hypopituitarism and the opportunity to intervene via hormone replacement, it is important to recognize the role of pituitary hormone deficiencies after TBI.
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Affiliation(s)
- Tamara L Wexler
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, 240 E 38th St 15th Floor, New York, NY, 10016, USA.
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Wexler TL, Reifschneider K, Backeljauw P, Cárdenas JF, Hoffman AR, Miller BS, Yuen KCJ. Growth Hormone Deficiency following Traumatic Brain Injury in Pediatric and Adolescent Patients: Presentation, Treatment, and Challenges of Transitioning from Pediatric to Adult Services. J Neurotrauma 2023. [PMID: 36825511 DOI: 10.1089/neu.2022.0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Traumatic brain injury (TBI) is increasingly recognized, with an incidence of approximately 110 per 100,000 in pediatric populations and 618 per 100,000 in adolescent and adult populations. TBI often leads to cognitive, behavioral, and physical consequences, including endocrinopathies. Deficiencies in anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, gonadotropins, and growth hormone [GH]) can negatively impact health outcomes and quality of life post-TBI. This review focuses on GH deficiency (GHD), the most common post-TBI pituitary hormone deficiency. GHD is associated with abnormal body composition, lipid metabolism, bone mineral density, executive brain functions, behavior, and height outcomes in pediatric, adolescent, and transition-age patients. Despite its relatively frequent occurrence, post-TBI GHD has not been well studied in these patients; hence, diagnostic and treatment recommendations are limited. Here, we examine the occurrence and diagnosis of TBI, retrospectively analyze post-TBI hypopituitarism and GHD prevalence rates in pediatric and adolescent patients, and discuss appropriate GHD testing strategies and GH dosage recommendations for these patients. We place particular emphasis on the ways in which testing and dosage recommendations may change during the transition phase. We conclude with a review of the challenges faced by transition-age patients and how these may be addressed to improve access to adequate healthcare. Little information is currently available to help guide patients with TBI and GHD through the transition phase and there is a risk of interrupted care; therefore, a strength of this review is its emphasis on this critical period in a patient's healthcare journey.
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Affiliation(s)
- Tamara L Wexler
- Department of Rehabilitation Medicine, NYU Langone Health, New York, New York, USA
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kent Reifschneider
- Children's Hospital of The King's Daughters, Eastern Virginia Medical Center, Norfolk, Virginia, USA
| | - Philippe Backeljauw
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Javier F Cárdenas
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
| | - Andrew R Hoffman
- Department of Medicine, Division of Endocrinology, Metabolism and Gerontology, Stanford University School of Medicine, Stanford, California, USA
| | - Bradley S Miller
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, M Health Fairview Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, USA
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Vlad RM, Albu AI, Nicolaescu ID, Dobritoiu R, Carsote M, Sandru F, Albu D, Păcurar D. An Approach to Traumatic Brain Injury-Related Hypopituitarism: Overcoming the Pediatric Challenges. Diagnostics (Basel) 2023; 13:diagnostics13020212. [PMID: 36673021 PMCID: PMC9857786 DOI: 10.3390/diagnostics13020212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI)-related hypopituitarism is a rare polymorphic complication of brain injury, with very little data, particularly concerning children and teenagers. This is a comprehensive review of the literature regarding this pathology, starting from a new pediatric case. The research was conducted on PubMed and included publications from the last 22 years. We identified nine original studies on the pediatric population (two case reports and seven studies; only four of these seven were prospective studies). TBI-related hypopituitarism is associated with isolated hormonal deficits ranging from 22.5% to 86% and multiple hormonal deficiencies from 5.9% to 50% in the studied pediatric population. Growth hormone (GH) deficiency is most often found, including the form with late occurrence after TBI; it was described as persistent in half of the studies. Thyroid-stimulating hormone (TSH) deficiency is identified as a distant complication following TBI; in all three studies, we identified this complication was found to be permanent. Adrenocorticotropic hormone (ACTH) deficiency did not relate to a certain type of brain trauma, and it was transient in reported cases. Hyperprolactinemia was the most frequent hormonal finding, also occurring late after injury. Central diabetes insipidus was encountered early post-TBI, typically with a transient pattern and did not relate to a particular type of injury. TBI-related hypopituitarism, although rare in children, should be taken into consideration even after a long time since the trauma. A multidisciplinary approach is needed if the patient is to safely overcome any acute condition.
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Affiliation(s)
- Raluca Maria Vlad
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence: (R.M.V.); (A.I.A.); Tel.: +40-722451462 (R.M.V.); +40-723886967 (A.I.A.)
| | - Alice Ioana Albu
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Elias” Emergency Clinical Hospital, 011461 Bucharest, Romania
- Correspondence: (R.M.V.); (A.I.A.); Tel.: +40-722451462 (R.M.V.); +40-723886967 (A.I.A.)
| | | | - Ruxandra Dobritoiu
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “C. I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Florica Sandru
- Department of Dermatovenerology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Elias” University Emergency Hospital, 011461 Bucharest, Romania
| | - Dragos Albu
- 2nd Clinical Department Obstetrics Gynecology, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Păcurar
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Children’s Hospital, 011743 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Muacevic A, Adler JR, Bari I, Khalid MU, Kirmani S, Bari ME. Endocrine Abnormalities in Children With Traumatic Brain Injury at a Tertiary Care Center. Cureus 2023; 15:e34131. [PMID: 36843696 PMCID: PMC9947722 DOI: 10.7759/cureus.34131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Objective Accidental traumatic brain injury (TBI) can lead to severe complications such as endocrine abnormalities and long-term morbidities and can negatively impact patient lives. These conditions are also associated with a high cost of treatment over a lifetime, a significant concern in low-to-middle-income countries (LMICs). In Pakistan, the prevalence of children with endocrine abnormalities secondary to TBI remains largely unexplored. We conducted a retrospective cross-sectional study to estimate the burden of endocrine abnormalities due to TBI among children in our population. Methods Twenty patients previously admitted with head injury between September and October 2019 were retrospectively reviewed with tests for baseline serum sodium, plasma osmolality, cortisol, adrenocorticotropin (ACTH), free thyroxine (fT4), growth hormone (GH), insulin growth factor-1 (IGF-1), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin, estradiol, and testosterone. Data were collated from the electronic Health and Information Management System (HIMS) and analyzed using SPSS v25. Chi-square and t-tests were used to identify associations between variable groups. Outcomes of interest included correlations between hormonal levels and demographic factors, interventions and hormonal levels, and complication rates and hormonal levels. Results Our study reports three (15% of the total cohort) patients with pituitary hormone deficits (two with low IGF-1 and one with low TSH). High serum IGF-1 and ACTH levels were also observed in three (15%) children. High IGF-1 was associated with female gender (p=0.007), mechanical ventilation (p=0.038), and falls (p=0.028). IGF-1 (p=0.035) and GH (p=0.049) levels were associated with improvement in Extended Glasgow Outcome Scale (GOS-E) score. Testosterone was positively correlated with a high percentile for height (p=0.005) and GOS-E scores on follow-up (p=0.030). High testosterone levels (592.12 ± 102.28 ng/dl) were associated with good functional outcomes in post-pubescent patients (p<0.05). Serum fT4 was linked with a high GOS-E score at discharge in prepubescent patients (p=0.034). Neurosurgical decompression was the only risk factor for hormone deficiency, comprising 67% of the group with hormone deficiencies (p=0.028). The learning difficulties were observed exclusively in children with hormonal deficiencies (7 patients, p=0.000). Conclusion Hormonal dysfunction due to TBI in children can lead to poor outcomes. High serum IGF-1, testosterone, and free T4 levels were associated with improved functional outcomes in children with TBI. Limited follow-up and resources in LMICs are significant barriers to addressing the morbidity associated with these conditions and need to be addressed at a health policy level.
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Yuen KCJ, Masel B, Jaffee MS, O'Shanick G, Wexler TL, Reifschneider K, Urban RJ, Hoang S, Kelepouris N, Hoffman AR. A consensus on optimization of care in patients with growth hormone deficiency and mild traumatic brain injury. Growth Horm IGF Res 2022; 66:101495. [PMID: 35933894 DOI: 10.1016/j.ghir.2022.101495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE/DESIGN Approximately 2.9 million children and adults in the US experience traumatic brain injuries (TBIs) annually, most of which are considered mild. TBI can induce varying consequences on pituitary function, with growth hormone deficiency (GHD) among the more commonly reported conditions. Panels of pediatric and adult endocrinologists, neurologists, physical medicine and rehabilitation specialists, and neuropsychologists convened in February and October 2020 to discuss ongoing challenges and provide strategies for detection and optimal management of patients with mild TBI and GHD. RESULTS Difficulties include a low rate of seeking medical attention in the population, suboptimal screening tools, cost and complexity of GHD testing, and a lack of consensus regarding when to test or retest for GHD. Additionally, referrals to endocrinologists from other specialists are uncommon. Recommendations from the panels for managing such patients included multidisciplinary guidelines on the diagnosis and management of post-TBI GHD and additional education on long-term metabolic and probable cognitive benefits of GH replacement therapy. CONCLUSION As patients of all ages with mild TBI may develop GHD and/or other pituitary deficiencies, a multidisciplinary approach to provide education to endocrinologists, neurologists, neurosurgeons, traumatologists, and other providers and guidelines for the early identification and management of persistent mild TBI-related GHD are urgently needed.
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Affiliation(s)
- Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, AZ, USA
| | - Brent Masel
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael S Jaffee
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | | | - Tamara L Wexler
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kent Reifschneider
- Division of Endocrinology, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - Randall J Urban
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Andrew R Hoffman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Virenque A, Koivisto H, Antila S, Zub E, Rooney EJ, Miszczuk D, Müller A, Stoka E, Marchi N, Alitalo K, Tanila H, Noe FM. Significance of developmental meningeal lymphatic dysfunction in experimental post-traumatic injury. Brain Behav Immun Health 2022; 23:100466. [PMID: 35694175 PMCID: PMC9184565 DOI: 10.1016/j.bbih.2022.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Understanding the pathological mechanisms unfolding after chronic traumatic brain injury (TBI) could reveal new therapeutic entry points. During the post-TBI sequel, the involvement of cerebrospinal fluid drainage through the meningeal lymphatic vessels was proposed. Here, we used K14-VEGFR3-Ig transgenic mice to analyze whether a developmental dysfunction of meningeal lymphatic vessels modifies post-TBI pathology. To this end, a moderate TBI was delivered by controlled cortical injury over the temporal lobe in male transgenic mice or their littermate controls. We performed MRI and a battery of behavioral tests over time to define the post-TBI trajectories. In vivo analyses were integrated by ex-vivo quantitative and morphometric examinations of the cortical lesion and glial cells. In post-TBI K14-VEGFR3-Ig mice, the recovery from motor deficits was protracted compared to littermates. This outcome is coherent with the observed slower hematoma clearance in transgenic mice during the first two weeks post-TBI. No other genotype-related behavioral differences were observed, and the volume of cortical lesions imaged by MRI in vivo, and confirmed by histology ex-vivo, were comparable in both groups. However, at the cellular level, post-TBI K14-VEGFR3-Ig mice exhibited an increased percentage of activated Iba1 microglia in the hippocampus and auditory cortex, areas that are proximal to the lesion. Although not impacting or modifying the structural brain damage and post-TBI behavior, a pre-existing dysfunction of meningeal lymphatic vessels is associated with morphological microglial activation over time, possibly representing a sub-clinical pathological imprint or a vulnerability factor. Our findings suggest that pre-existing mLV deficits could represent a possible risk factor for the overall outcome of TBI pathology. Developmental deficit in the meningeal lymphatic vessels contributes to sustain the chronic neuroinflammation and represent a susceptibility factor in TBI, despite the lack of a functional phenotype. Development and progression of TBI-related cortical lesion is not exacerbated by developmental deficit in meningeal lymphatics. Meningeal lymphatic developmental deficits result in increased neuroinflammation, suggesting a sub-clinical pathological imprint or a vulnerability factor. Congenital mLV deficit affects the interstitial fluid dynamics and the post-TBI hematoma resolution.
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Affiliation(s)
- Anaïs Virenque
- Neuroscience Center, Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00290, Helsinki, Finland
| | - Hennariikka Koivisto
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210, Kuopio, Finland
| | - Salli Antila
- Wihuri Research Institute and Translational Cancer Medicine Program, Biomedicum Helsinki, University of Helsinki, 00290, Helsinki, Finland
| | - Emma Zub
- Cerebrovascular and Glia Research, Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Erin Jane Rooney
- Neuroscience Center, Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00290, Helsinki, Finland
| | - Diana Miszczuk
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210, Kuopio, Finland
| | - Adrian Müller
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210, Kuopio, Finland
| | - Enija Stoka
- Neuroscience Center, Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00290, Helsinki, Finland
| | - Nicola Marchi
- Cerebrovascular and Glia Research, Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Medicine Program, Biomedicum Helsinki, University of Helsinki, 00290, Helsinki, Finland
| | - Heikki Tanila
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210, Kuopio, Finland
| | - Francesco Mattia Noe
- Neuroscience Center, Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00290, Helsinki, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, 70210, Kuopio, Finland
- Corresponding author. HiLIFE, Neuroscience Center, Helsinki University, Helsinki, Finland.
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Abstract
Puberty, which in humans is considered to include both gonadarche and adrenarche, is the period of becoming capable of reproducing sexually and is recognized by maturation of the gonads and development of secondary sex characteristics. Gonadarche referring to growth and maturation of the gonads is fundamental to puberty since it encompasses increased gonadal steroid secretion and initiation of gametogenesis resulting from enhanced pituitary gonadotropin secretion, triggered in turn by robust pulsatile GnRH release from the hypothalamus. This chapter reviews the development of GnRH pulsatility from before birth until the onset of puberty. In humans, GnRH pulse generation is restrained during childhood and juvenile development. This prepubertal hiatus in hypothalamic activity is considered to result from a neurobiological brake imposed upon the GnRH pulse generator resident in the infundibular nucleus. Reactivation of the GnRH pulse generator initiates pubertal development. Current understanding of the genetics and physiology of the brake will be discussed, as will hypotheses proposed to account for timing the resurgence in pulsatile GnRH and initiation of puberty. The chapter ends with a discussion of disorders associated with precocious or delayed puberty with a focus on those with etiologies attributed to aberrant GnRH neuron anatomy or function. A pediatric approach to patients with pubertal disorders is provided and contemporary treatments for both precocious and delayed puberty outlined.
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Affiliation(s)
- Selma Feldman Witchel
- Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Tony M Plant
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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11
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West AN, Diaz-Thomas AM, Shafi NI. Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward. Front Neurol 2020; 11:551923. [PMID: 33324312 PMCID: PMC7726201 DOI: 10.3389/fneur.2020.551923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/16/2020] [Indexed: 11/21/2022] Open
Abstract
Neuroendocrine dysfunction can occur as a consequence of traumatic brain injury (TBI), and disruptions to the hypothalamic-pituitary axis can be especially consequential to children. The purpose of our review is to summarize current literature relevant to studying sex differences in pediatric post-traumatic hypopituitarism (PTHP). Our understanding of incidence, time course, and impact is constrained by studies which are primarily small, are disadvantaged by significant methodological challenges, and have investigated limited temporal windows. Because hormonal changes underpin the basis of growth and development, the timing of injury and PTHP testing with respect to pubertal stage gains particular importance. Reciprocal relationships among neuroendocrine function, TBI, adverse childhood events, and physiological, psychological and cognitive sequelae are underconsidered influencers of sexually dimorphic outcomes. In light of the tremendous heterogeneity in this body of literature, we conclude with the common path upon which we must collectively arrive in order to make progress in understanding PTHP.
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Affiliation(s)
- Alina Nico West
- Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Alicia M Diaz-Thomas
- Division of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nadeem I Shafi
- Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
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12
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The protective effects of prolactin on brain injury. Life Sci 2020; 263:118547. [PMID: 33038380 DOI: 10.1016/j.lfs.2020.118547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022]
Abstract
AIMS Brain injuries based on their causes are divided into two categories, TBI and NTBI. TBI is caused by damages such as head injury, but non-physical injury causes NTBI. Prolactin is one of the blood factors that increase during brain injury. It has been assumed to play a regenerative role in post-injury recovery. MATERIALS AND METHODS In this review, various valid papers from electronic sources (including Web of Science, Scopus, PubMed, SID, Google Scholar, and ISI databases) used, which in them the protective effect of prolactin on brain injury investigated. KEY FINDINGS Inflammation following brain injury with the production of pro-inflammatory cytokines in the affected area can even lead to excitotoxicity and cell death in the damaged area. Medical brain damage treatments are long-term, and can have several side effects. Therefore, it is better to consider medication treatments that have fewer side effects and greater efficacy. Research suggests that prolactin has numerous regenerative effects on brain injury, and prevents cell death. Prolactin is one of the hormones produced in the body; therefore it has fewer side effects and may be more effective because it increases during brain injury. SIGNIFICANCE Prolactin can be used peripherally and centrally, and exerts its neuro regenerative effects against further damage post-TBI and NTBI.
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13
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Yuen KCJ, Masel BE, Reifschneider KL, Sheffield-Moore M, Urban RJ, Pyles RB. Alterations of the GH/IGF-I Axis and Gut Microbiome after Traumatic Brain Injury: A New Clinical Syndrome? J Clin Endocrinol Metab 2020; 105:5862647. [PMID: 32585029 DOI: 10.1210/clinem/dgaa398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/18/2020] [Indexed: 12/22/2022]
Abstract
CONTEXT Pituitary dysfunction with abnormal growth hormone (GH) secretion and neurocognitive deficits are common consequences of traumatic brain injury (TBI). Recognizing the comorbidity of these symptoms is of clinical importance; however, efficacious treatment is currently lacking. EVIDENCE ACQUISITION A review of studies in PubMed published between January 1980 to March 2020 and ongoing clinical trials was conducted using the search terms "growth hormone," "traumatic brain injury," and "gut microbiome." EVIDENCE SYNTHESIS Increasing evidence has implicated the effects of TBI in promoting an interplay of ischemia, cytotoxicity, and inflammation that renders a subset of patients to develop postinjury hypopituitarism, severe fatigue, and impaired cognition and behavioral processes. Recent data have suggested an association between abnormal GH secretion and altered gut microbiome in TBI patients, thus prompting the description of a hypothesized new clinical syndrome called "brain injury associated fatigue and altered cognition." Notably, these patients demonstrate distinct characteristics from those with GH deficiency from other non-TBI causes in that their symptom complex improves significantly with recombinant human GH treatment, but does not reverse the underlying mechanistic cause as symptoms typically recur upon treatment cessation. CONCLUSION The reviewed data describe the importance of alterations of the GH/insulin-like growth factor I axis and gut microbiome after brain injury and its influence in promoting neurocognitive and behavioral deficits in a bidirectional relationship, and highlight a new clinical syndrome that may exist in a subset of TBI patients in whom recombinant human GH therapy could significantly improve symptomatology. More studies are needed to further characterize this clinical syndrome.
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Affiliation(s)
- Kevin C J Yuen
- Barrow Pituitary Center, Barrow Neurological Institute and St. Joseph's Hospital and Medical Center, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona
| | | | - Kent L Reifschneider
- Division of Endocrinology, Children's Specialty Group, Children's Hospital of The King's Daughters, Norfolk, Virginia
| | - Melinda Sheffield-Moore
- Department of Health and Kinesiology, Texas A & M University, College Station, Texas
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555
| | - Richard B Pyles
- Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
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14
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Plavov O, Martinez-Perez R, Garcia-Ballestas E, Agrawal A, Moscote-Salazar LR. Re: A national survey of clinical practice of surveillance for post-traumatic brain injury hypopituitarism in the United Kingdom and Ireland. Br J Neurosurg 2020; 35:800. [PMID: 32401048 DOI: 10.1080/02688697.2020.1766664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Rafael Martinez-Perez
- Department of Neurosurgery, Wexner Medical Center, The Ohio State university, Columbus, OH, USA
| | | | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, Madhya Pradesh, India
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15
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Aggarwal S, Fogel J, Kumar K, Shabbir N. Trauma and thyroid-stimulating hormone abnormalities in pediatric patients. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619845766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background There is limited literature on trauma and endocrine abnormalities in the pediatric trauma setting. Aim We studied demographic, medical history, injury experience, and mortality factors to determine their association with abnormal thyroid-stimulating hormone in pediatric trauma patients. Methods The 414 pediatric trauma patients were from those seen at an emergency department. The primary outcome variable was abnormal thyroid-stimulating hormone. Secondary outcome variables were abnormal high and abnormal low thyroid-stimulating hormone. Predictor variables were demographics (age, sex, race/ethnicity, body mass index), medical history (thyroid disease, diabetes mellitus, autoimmune disease, psychiatric disease), injury experience (injury cause, injury severity score ≥ 15, moderate/severe traumatic brain injury, length of stay), and mortality (mortality, survival probability). Multivariate logistic regression analyses were conducted. Results There were 8.0% ( n = 33) with any abnormal thyroid-stimulating hormone value. In the analysis for abnormal thyroid-stimulating hormone, females (odds ratio:4.95, 95% confidence interval: 2.01, 12.21, p < 0.01) and traumatic brain injury (odds ratio: 8.11, 95% confidence interval: 2.51, 26.16, p < 0.001) were each significantly associated with increased odds. In the analysis for abnormal high thyroid-stimulating hormone (odds ratio: 3.75, 95% confidence interval: 1.37, 10.24, p < 0.05), traumatic brain injury (odds ratio: 11.59, 95% confidence interval: 3.45, 38.97, p < 0.001), and mortality (odds ratio: 35.59, 95% confidence interval: 1.40, 906.57, p < 0.05) were each significantly associated with increased odds. In the analysis for abnormal low thyroid-stimulating hormone, only females (odds ratio: 11.10, 95% confidence interval: 1.26, 97.60, p < 0.05) were significantly associated with increased odds. Conclusion In conclusion, females and traumatic brain injury have increased odds for abnormal thyroid-stimulating hormone. Mortality has increased odds for abnormal high thyroid-stimulating hormone. We suggest that clinicians in the pediatric trauma setting carefully monitor females and traumatic brain injury patients with abnormal thyroid-stimulating hormone.
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Affiliation(s)
- Shefali Aggarwal
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
| | - Joshua Fogel
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - Krishan Kumar
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
| | - Nadeem Shabbir
- Department of Pediatrics, Nassau University Medical Center, East Meadow, NY, USA
- Department of Pediatrics, New York College of Osteopathic Medicine, New York, NY, USA
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16
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Ortiz JB, Sukhina A, Balkan B, Harootunian G, Adelson PD, Lewis KS, Oatman O, Subbian V, Rowe RK, Lifshitz J. Epidemiology of Pediatric Traumatic Brain Injury and Hypothalamic-Pituitary Disorders in Arizona. Front Neurol 2020; 10:1410. [PMID: 32038466 PMCID: PMC6988738 DOI: 10.3389/fneur.2019.01410] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/24/2019] [Indexed: 01/25/2023] Open
Abstract
Traumatic brain injury (TBI) in children can result in long-lasting social, cognitive, and neurological impairments. In adults, TBI can lead to endocrinopathies (endocrine system disorders), but this is infrequently reported in children. Untreated endocrinopathies can elevate risks of subsequent health issues, such that early detection in pediatric TBI survivors can initiate clinical interventions. To understand the risk of endocrinopathies following pediatric TBI, we identified patients who had experienced a TBI and subsequently developed a new-onset hypothalamic regulated endocrinopathy (n = 498). We hypothesized that pediatric patients who were diagnosed with a TBI were at higher risk of being diagnosed with a central endocrinopathy than those without a prior diagnosis of TBI. In our epidemiological assessment, we identified pediatric patients enrolled in the Arizona Health Care Cost Containment System (AHCCCS) from 2008 to 2014 who were diagnosed with one of 330 TBI International Classification of Diseases (ICD)-9 codes and subsequently diagnosed with one of 14 central endocrinopathy ICD-9 codes. Additionally, the ICD-9 code data from over 600,000 Arizona pediatric patients afforded an estimate of the incidence, prevalence, relative risk, odds ratio, and number needed to harm, regarding the development of a central endocrinopathy after sustaining a TBI in Arizona Medicaid pediatric patients. Children with a TBI diagnosis had 3.22 times the risk of a subsequent central endocrine diagnosis compared with the general population (±0.28). Pediatric AHCCCS patients with a central endocrine diagnosis had 3.2-fold higher odds of a history of a TBI diagnosis than those without an endocrine diagnosis (±0.29). Furthermore, the number of patients with a TBI diagnosis for one patient to receive a diagnosis of a central endocrine diagnosis was 151.2 (±6.12). Female subjects were more likely to present with a central endocrine diagnosis after a TBI diagnosis compared to male subjects (64.1 vs. 35.9%). These results are the first state-wide epidemiological study conducted to determine the risk of developing a hypothalamic-pituitary disorder after a TBI in the pediatric population. Our results contribute to a body of knowledge demonstrating a TBI etiology for idiopathic endocrine disorders, and thus advise physicians with regard to TBI follow-up care that includes preventive screening for endocrine disorders.
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Affiliation(s)
- J Bryce Ortiz
- Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Alona Sukhina
- Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Baran Balkan
- College of Engineering, University of Arizona, Tucson, AZ, United States
| | - Gevork Harootunian
- Center for Health Information and Research, Arizona State University, Tempe, AZ, United States
| | - P David Adelson
- Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Kara S Lewis
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Oliver Oatman
- Endocrinology, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Vignesh Subbian
- College of Engineering, University of Arizona, Tucson, AZ, United States
| | - Rachel K Rowe
- Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Phoenix Veteran Affairs Health Care System, Phoenix, AZ, United States
| | - Jonathan Lifshitz
- Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Phoenix Veteran Affairs Health Care System, Phoenix, AZ, United States
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17
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Weil ZM, Karelina K. Lifelong consequences of brain injuries during development: From risk to resilience. Front Neuroendocrinol 2019; 55:100793. [PMID: 31560884 PMCID: PMC6905510 DOI: 10.1016/j.yfrne.2019.100793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/23/2019] [Accepted: 09/23/2019] [Indexed: 10/26/2022]
Abstract
Traumatic brain injuries in children represent a major public health issue and even relatively mild injuries can have lifelong consequences. However, the outcomes from these injuries are highly heterogeneous, with most individuals recovering fully, but a substantial subset experiencing prolonged or permanent disabilities across a number of domains. Moreover, brain injuries predispose individuals to other kinds of neuropsychiatric and somatic illnesses. Critically, the severity of the injury only partially predicts subsequent outcomes, thus other factors must be involved. In this review, we discuss the psychological, social, neuroendocrine, and autonomic processes that are disrupted following traumatic brain injury during development, and consider the mechanisms the mediate risk or resilience after traumatic brain injury in this vulnerable population.
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Affiliation(s)
- Zachary M Weil
- Department of Neuroscience, Group in Behavioral Neuroendocrinology, Center for Brain and Spinal Cord Repair, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Kate Karelina
- Department of Neuroscience, Group in Behavioral Neuroendocrinology, Center for Brain and Spinal Cord Repair, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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18
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Abstract
PURPOSE To estimate the total number of articles on traumatic brain injury (TBI)-related hypopituitarism and patients (including children and adolescents) with such disorder that were published until now, particularly after the author's review published on April 2000. METHODS Review of the literature retrievable on PubMed. RESULTS TBI-related hypopituitarism accounts for 7.2% of the whole literature on hypopituitarism published during the 18 years and half between May 2000 and October 2018. As a result, the total number of patients with TBI-related hypopituitarism now approximates 2200. A number of patients, both adults and children, continue to be published as case reports. Articles, including reviews and guidelines, have been published in national languages in order to maximize locally the information on TBI-related hypopituitarism. TBI-related hypopituitarism has been also studied in animals (rodents, cats and dogs). CONCLUSIONS The interest for the damage suffered by anterior pituitary as a result of TBI continues to remain high both in the adulthood and childhood.
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Affiliation(s)
- Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy.
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, 98125, Messina, Italy.
- Interdepartmental Program on Molecular & Clinical Endocrinology, and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Padiglione H, 4 Piano, 98125, Messina, Italy.
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19
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Kim YY, Chao JR, Kim C, Jung H, Kim B, Kang TC, Chang J, Park HS, Suh JG, Lee JH. Comparing the Superficial Vasculature of the Central Nervous System in Six Laboratory Animals: A Hypothesis About the Role of the "Circle of Willis". Anat Rec (Hoboken) 2019; 302:2049-2061. [PMID: 31087813 DOI: 10.1002/ar.24146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 11/08/2022]
Abstract
We provide images of the entire central nervous system vasculature, and compare the anatomical findings in six different laboratory animals. A detailed understanding of the specific anatomy for each is important in the design of experimental modeling and for understanding the specific function of each target organ. Six different types of animals, the Korean wild mouse, C57BL/6J mouse, F344 rat, mongolian gerbil, Syrian hamsters, and guinea pigs, were included. To stain the blood vessels in each of the animals, Alcian blue reagent was used to perfuse each species. The bifurcation and anastomotic patterns of the anterior cerebral arteries differed in each species. The vascular supply to the olfactory nerve was visualized as a single artery supplying both olfactory nerves, and arteries supplying the lateral portion of the olfactory nerves originating from the olfactory bulb area. The posterior communicating arteries of the six animals demonstrated unique morphologies. The shape of the hypophyseal portal system varied by species. Most animals used in this study had a hexagonal Circle of Willis, except for the Korean wild mouse. Using this approach, we successfully mapped the brain vascular system in six different species of animals. This information and the images created can guide other researchers as they design research studies and create experimental models for new surgical procedures and approaches. Anat Rec, 2019. © 2019 Wiley Periodicals, Inc. Anat Rec, 302:2049-2061, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
- Yoo Yeon Kim
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Janet Ren Chao
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Harry Jung
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Boyoung Kim
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Tae-Cheon Kang
- Department of Anatomy and Neurobiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hae Sang Park
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jun-Gyo Suh
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jun Ho Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
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20
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Dassa Y, Crosnier H, Chevignard M, Viaud M, Personnier C, Flechtner I, Meyer P, Puget S, Boddaert N, Breton S, Polak M. Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study. Eur J Endocrinol 2019; 180:281-290. [PMID: 30884465 DOI: 10.1530/eje-19-0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/07/2019] [Indexed: 11/08/2022]
Abstract
Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3-4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<-1 DS) or low IGF-1 (<-2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5-10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4-6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.
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Affiliation(s)
- Yamina Dassa
- Paediatric Endocrinology, Gynaecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Hélène Crosnier
- Paediatric Endocrinology, Gynaecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Mathilde Chevignard
- Rehabilitation Department for Children and Adolescents with Acquired Neurological Injury, Saint-Maurice Hospitals, Saint-Maurice, France
- Laboratoire d'Imagerie Biomédicale and GRC HanCRe, Sorbonne University, Paris, France
| | - Magali Viaud
- Paediatric Endocrinology, Gynaecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | | | - Isabelle Flechtner
- Paediatric Endocrinology, Gynaecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Philippe Meyer
- Paediatric Anaesthesiology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
- Paris Descartes University, Paris, France
| | - Stéphanie Puget
- Paris Descartes University, Paris, France
- Paediatric Neurosurgery Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Nathalie Boddaert
- Paris Descartes University, Paris, France
- Radiology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Sylvain Breton
- Radiology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
| | - Michel Polak
- Paediatric Endocrinology, Gynaecology and Diabetology Unit, Assistance Publique-Hôpitaux de Paris, Necker Enfants-Malades University Hospital, Paris, France
- Paris Descartes University, Paris, France
- IMAGINE Institute Affiliate, Paris, France
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21
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Flaherty E, Legano L, Idzerda S, Sirotnak AP, Budzak AE, Gavril AR, Haney SB, Laskey A“T, Messner SA, Moles RL, Palsuci VJ. Ongoing Pediatric Health Care for the Child Who Has Been Maltreated. Pediatrics 2019; 143:peds.2019-0284. [PMID: 30886109 DOI: 10.1542/peds.2019-0284] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician's role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences.
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Affiliation(s)
- Emalee Flaherty
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Lori Legano
- Department of Pediatrics, School of Medicine, New York University, New York, New York; and
| | - Sheila Idzerda
- Billings Clinic Bozeman Acorn Pediatrics, Bozeman, Montana
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22
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Gray S, Bilski T, Dieudonne B, Saeed S. Hypopituitarism After Traumatic Brain Injury. Cureus 2019; 11:e4163. [PMID: 31065469 PMCID: PMC6497183 DOI: 10.7759/cureus.4163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/01/2019] [Indexed: 02/02/2023] Open
Abstract
Acquired hypopituitarism is associated with traumatic brain injury. This neuroendocrine dysfunction can cause both short-term and long-term morbidity resulting in a cognitive, physiological, and behavioral decline, which increases the burden of the disease and the cost of care. Data in the trauma literature is derisory on this subject. The aim of this review is to edify clinicians on this condition, outline the screening criteria and methods for hypopituitarism after traumatic brain injury, and bring awareness to the chronic effects.
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Affiliation(s)
- Sanjiv Gray
- Surgery, University of Central Florida, Orlando, USA
| | - Tracy Bilski
- Surgery, University of South Florida Morsani College of Medicine, Kissimmee, USA
| | | | - Saqib Saeed
- Surgery, Harlem Hospital Center, New York, USA
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23
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Rose SR. Management options for pediatric growth hormone deficiency. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1564036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Susan R. Rose
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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24
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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 (Lausanne) 2019; 10:149. [PMID: 30941101 PMCID: PMC6433821 DOI: 10.3389/fendo.2019.00149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/20/2019] [Indexed: 01/07/2023] Open
Abstract
Objective: The aim of this study was to evaluate the frequency of hypopituitarism following TBI in a cohort of children who had been hospitalized for mild TBI and to identify the predictive factors for this deficiency. Design: A prospective study was conducted on children between 2 and 16 years of age who had been hospitalized for mild TBI according to the Glasgow Coma Scale between September 2009 and June 2013. Clinical parameters, basal pituitary hormone assessment at 0, 6, and 12 months, as well as a dynamic testing (insulin tolerance test) 12 months after TBI were performed. Results: The study included 109 children, the median age was 8.5 years. Patients were examined 6 months (n = 99) and 12 months (n = 96) after TBI. Somatotropic deficiency (defined by a GH peak <20 mUI/l in two tests, an IGF-1 <-1SDS and a delta height <0SDS) were confirmed in 2 cases. One case of gonadotrophic deficiency occurred 1 year after TBI among 13 pubertal children. No cases of precocious puberty, 5 cases of low prolactin level, no cases of corticotropic insufficiency (cortisol peak <500 nmol/l) and no cases diabetes insipidus were recorded. Conclusion: Pituitary insufficiency was present 1year after mild TBI in about 7% of children. Based on our results, we suggest testing children after mild TBI in case of clinical abnormalities. i.e., for GH axis, IGF-1, which should be assessed in children with a delta height <0 SDS, 6 to 12 months after TBI, and a dynamic GH testing (preferentially by an ITT) should be performed in case of IGF-1 <-1SDS, with a GH threshold at 20 mUI/L. However, if a systematic pituitary assessment is not required for mild TBI, physicians should monitor children 1 year after mild TBI with particular attention to growth and weight gain.
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Affiliation(s)
- Claire Briet
- Department of Pediatrics, University Medical Center, Amiens, France
- Department of Endocrinology, Diabetology and Nutrition, Institut MITOVASC, INSERM U1083, Angers University, University Medical Center, Angers, France
- *Correspondence: Claire Briet
| | - Karine Braun
- Department of Pediatrics, University Medical Center, Amiens, France
| | - Michel Lefranc
- Department of Neurosurgery, University Medical Center, Amiens, France
- Department of Medicine, University of Picardie Jules Verne, Amiens, France
| | - Patrick Toussaint
- Department of Neurosurgery, University Medical Center, Amiens, France
- Department of Medicine, University of Picardie Jules Verne, Amiens, France
| | - Bernard Boudailliez
- Department of Pediatrics, University Medical Center, Amiens, France
- Department of Medicine, University of Picardie Jules Verne, Amiens, France
| | - Hélène Bony
- Department of Pediatrics, University Medical Center, Amiens, France
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25
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Fan E, Skippen PW, Sargent MA, Cochrane DD, Chanoine JP. Central adrenal insufficiency following traumatic brain injury: a missed diagnosis in the critically injured. Childs Nerv Syst 2017; 33:2205-2207. [PMID: 28721596 DOI: 10.1007/s00381-017-3536-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND High-dose steroid administration is no longer recommended in the treatment of acute traumatic brain injury (TBI) as it failed to prove beneficial in improving patients' outcome. However, a masked benefit of steroid administration in TBI management was that it provided corticosteroid replacement therapy in patients with TBI-related central adrenal insufficiency. CASE PRESENTATION We report the case of a 12-year-old boy who suffered a severe TBI from a motor vehicle accident that resulted in complete deficiency of anterior pituitary function. Central adrenal insufficiency was not ruled out by a near normal response to a low-dose ACTH test performed on D11. CONCLUSION Consideration should be given to the empirical treatment of TBI pediatric patients with stress doses of corticosteroids if injury to the hypothalamus or pituitary gland is possible until a formal assessment of the hypothalamic-pituitary-adrenal axis can be made.
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Affiliation(s)
- Eileen Fan
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Peter W Skippen
- Pediatric Intensive Care Unit, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Michael A Sargent
- Department of Radiology, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - David D Cochrane
- Division of Neurosurgery, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Jean-Pierre Chanoine
- Endocrinology and Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
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Gilis-Januszewska A, Kluczyński Ł, Wilusz M, Pantofliński J, Turek-Jabrocka R, Pach D, Hubalewska-Dydejczyk A. Pituitary insufficiency following traumatic thoracic injury in an adolescent male patient: A case report and literature review. Medicine (Baltimore) 2017; 96:e8406. [PMID: 29095270 PMCID: PMC5682789 DOI: 10.1097/md.0000000000008406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Traumatic thoracic injuries in adolescents are rare but could be connected with traumatic brain injuries (TBI) and development of chronic hypopituitarism. Early recognition of these endocrine problems is a significant challenge to clinicians. We present difficulties in diagnosis of hypothalamic-pituitary insufficiency following traumatic thoracic injury in adolescence. We also review the literature of similar cases. PATIENT CONCERNS We present a case of a 24-years-old male. In 2007, at the age of 15 he underwent a severe traffic accident followed by thoracic injury with concussion, hemothorax and dissection of the aorta requiring aortic stent-graft implantation. DIAGNOSES During the post-traumatic period, transient polydipsia and polyuria symptoms were observed. The patient had no medical history of any serious disease before the accident, his growth and pubertal development was normal. After the accident the patient did not undergo any routine medical check-ups. In 2013 gonadal axis deficiency was diagnosed during investigation of libido problems. Following the diagnosis testosterone replacement therapy was initiated. INTERVENTIONS Further endocrinological investigation was carried out in 2016. The patient's main complaints were decreased mood and poor physical fitness. BMI was 27.34 kg/m, with a tendency to abdominal fat distribution. The patient's height is 160 cm, while Mid Parental Height (MPH) is 173.5 cm. Decreased bone density was found in DEXA examination. Serum growth hormone level (GH) was normal while insulin-like growth factor-1 (IGF-1) level was below normal. Insulin tolerance test (ITT) and low levels of IGF-1 confirmed somatotropic axis deficiency. Nuclear magnetic resonance (NMR) of the hypothalamo-pituitary region showed no abnormalities. PROP 1 and other common genetic mutations associated with GH deficits were excluded. Testosterone treatment was continued. The patient increased physical activity and implemented diet. OUTCOMES The patient has lost weight, improved physical activity performance and is feeling better. The procedure to start GH supplementation is now in process. LESSONS Based on our case and available literature we suggest that adolescent patients after traumatic brain injuries may require precise investigation and strict monitoring due to the possibility of unrecognized hypopituitarism.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Łukasz Kluczyński
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | | | | | - Renata Turek-Jabrocka
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Dorota Pach
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
| | - Alicja Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College
- Department of Endocrinology, University Hospital, Kraków, Poland
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27
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Ewing-Cobbs L, Prasad MR, Cox CS, Granger DA, Duque G, Swank PR. Altered stress system reactivity after pediatric injury: Relation with post-traumatic stress symptoms. Psychoneuroendocrinology 2017; 84:66-75. [PMID: 28667938 PMCID: PMC5555029 DOI: 10.1016/j.psyneuen.2017.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/22/2017] [Accepted: 06/08/2017] [Indexed: 12/14/2022]
Abstract
Injury is the leading cause of death and disability in childhood. Injured children are at high risk for developing alterations in stress response systems and post-traumatic stress symptoms (PTSS) that may compromise long-term physical and psychological health. In a prospective, observational cohort study, we examined individual differences in, and correlates of, stress-reactivity of the hypothalamic-pituitary-adrenal axis (HPA; salivary cortisol) and autonomic nervous system (ANS; salivary alpha amylase, sAA) following pediatric injury. Participants were 8-15 years of age and hospitalized for traumatic brain injury (TBI; n=55; M age=13.9 yrs; 40 males) or extracranial injury (EI; n=29; M age 12.3 yrs, 20 males) following vehicular accidents. Six months post-injury, saliva was collected before and after the Trier Social Stress Test and later assayed for cortisol and sAA. Relative to a healthy non-injured comparison group (n=33; M age=12.5 yrs, 16 males), injured children (ages 8-12 years), but not adolescents (ages 13-15 yrs), had higher cortisol levels; regardless of age, injured participants showed dampened cortisol reactivity to social evaluative threat. Compared to participants with EI, children with TBI had elevated cortisol and adolescents had elevated sAA. With respect to PTSS, individual differences in sAA were negatively correlated with avoidance in the TBI group and positively correlated with emotional numbing within the EI group. Importantly, psychological and neurobiological sequelae were weakly related to injury severity. Given the high prevalence of pediatric injury, these sequelae affect many children and represent a significant public health concern. Consequently, surveillance of post-traumatic sequelae should include the full spectrum of injury severity. Monitoring the activity, reactivity, and regulation of biological systems sensitive to environmental insults may advance our understanding of individual differences in sequelae and adaptation following traumatic pediatric injury.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, United States.
| | - Mary R Prasad
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, United States
| | - Charles S Cox
- Department of Pediatric Surgery, University of Texas Health Science Center at Houston, United States
| | - Douglas A Granger
- Department of Psychology and Social Behavior, Pediatrics, and Public Health and Institute for Interdisciplinary Salivary Bioscience, University of California Irvine, United States; School of Nursing, Bloomberg School of Public Health, and School of Medicine, Johns Hopkins University, United States
| | - Gerardo Duque
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, United States
| | - Paul R Swank
- School of Public Health, University of Texas Health Science Center at Houston, United States
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28
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Ryan NP, Catroppa C, Godfrey C, Noble-Haeusslein LJ, Shultz SR, O'Brien TJ, Anderson V, Semple BD. Social dysfunction after pediatric traumatic brain injury: A translational perspective. Neurosci Biobehav Rev 2016; 64:196-214. [PMID: 26949224 PMCID: PMC5627971 DOI: 10.1016/j.neubiorev.2016.02.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
Social dysfunction is common after traumatic brain injury (TBI), contributing to reduced quality of life for survivors. Factors which influence the development or persistence of social deficits after injury remain poorly understood, particularly in the context of ongoing brain maturation during childhood and adolescence. Aberrant social interactions have recently been modeled in adult and juvenile rodents after experimental TBI, providing an opportunity to gain new insights into the underlying neurobiology of these behaviors. Here, we review our current understanding of social dysfunction in both humans and rodent models of TBI, with a focus on brain injuries acquired during early development. Modulators of social outcomes are discussed, including injury-related and environmental risk and resilience factors. Disruption of social brain network connectivity and aberrant neuroendocrine function are identified as potential mechanisms of social impairments after pediatric TBI. Throughout, we highlight the overlap and disparities between outcome measures and findings from clinical and experimental approaches, and explore the translational potential of future research to prevent or ameliorate social dysfunction after childhood TBI.
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Affiliation(s)
- Nicholas P Ryan
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Cathy Catroppa
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Psychology, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Celia Godfrey
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia.
| | - Linda J Noble-Haeusslein
- Departments of Neurological Surgery and Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA.
| | - Sandy R Shultz
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
| | - Terence J O'Brien
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
| | - Vicki Anderson
- Australian Centre for Child Neuropsychological Studies, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia; Department of Psychology, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Bridgette D Semple
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC, Australia.
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