Hypothalamic and pituitary affection after traumatic brain injury in childhood

Introduction: During the past few years evidence suggests that there is an affection of the hypothalamic-pituitary system even after a moderate traumatic brain injury (TBI). Until recently little has been known about how often and after what kind of injury they result. Furthermore nothing is known about the clinical relevance. Possible causes could be primary as well as secondary traumatic lesions in the region of the hypothalamic-pituitary system.

Material and methods: Prospectively designed study with adult men who suffered a traumatic brain injury (II.-III. Grade) in their childhood. The middle latency period to incident was 16 years. We looked for and analysed the following conditions:

• Clinical and laboratory signs for a hypothalamic-pituitary dysfunction

• Anatomic structure and measurement of the hypothalamus and the pituitary gland with a magnetic resonance tomography (3-Tesla)

• Clinical neurologic outcome

• Initial data of the accident for example the mechanism, localisation and kind of the brain lesion

Result: In our study we examined 18 male patients with a middle time in coma more then 3 days. The middle initial Glasgow coma scale was about 7 points. Within our clinical and laboratory examinations we could not detect significant deficits in the hypothalamic-pituitary system.

The examination with des MRI showed several posttraumatic residual damages. The analysis of the pituitary structure demonstrated abnormalities, but no significant pathology.

Discussion: Within our study we could demonstrate that there are some abnormalities after a TBI in the childhood, but we could not detect significant pathologies in the hypothalamic-pituitary system. We could not exclude that there were transient dysfunctions in the area of the hypothalamus and pituitary gland.