Trauma cranioencefálico leve e hipopituitarismo imediato em crianças / Mild traumatic brain injury and immediate hypopituitarism in children

ABSTRACT

Aims: Traumatic brain injury is a common and costly trauma that may lead to hypopituitarism. Its complications may have great impact on public health, especially in children. This study evaluates the prevalence of immediate hypopituitarism in children who suffered mild traumatic brain injury. Methods: Children who were admitted in the emergency service of Unidade Regional de Emergência – Conjunto Hospitalar de Sorocaba due to traumatic brain injury were evaluated for the study. Every patient underwent a head computed tomography at admittance and was classified according to the Glasgow Coma Scale, being traumatic brain injury graded in severe (<9), moderate (9-12) or mild (>12). Those whose parents or guardians agreed to participate and presented mild trauma were included in the study and invited to perform a neuroendocrinological evaluation. Results: Sixty-eight children were admitted with traumatic brain injury, and 21 agreed to participate. Five patients did not perform the urine and blood exams, two had a moderate TBI, and one had a severe TBI, and therefore were excluded from data analysis. Among the 13 patients whose exams were performed in less than 48 hours from the trauma, five (38.5%) presented hormonal alterations, respectively single thyroid-stimulant hormone (TSH) elevation, single insuline-like growth factor 1 (IGF-1) elevation, single cortisol elevation, combined folicule-stimulant hormone (FSH) and prolactin elevation, and combined TSH and FSH elevation. None presented symptoms of hypopituitarism. There was no association between head image alterations and hypopituitarism. Conclusions: The results found in this study lead to probably little significant endocrine dysfunctions, as such hormonal increases may be related to acute trauma response. Considering the literature and the results, it is possible to speculate that the relationship of traumatic brain injury with hypopituitarism in children is different from adults.

RESUMO

Objetivos: O trauma cranioencefálico é um trauma comum e dispendioso que pode levar a hipopituitarismo. Suas complicações podem ter grande impacto na saúde pública, especialmente em crianças. Este estudo avalia a prevalência de hipopituitarismo imediato em crianças que sofreram lesão cerebral traumática leve. Métodos: Foram avaliadas para o estudo crianças admitidas no serviço de emergência da Unidade Regional de Emergência – Conjunto Hospitalar de Sorocaba devido a um trauma cranioencefálico. Cada paciente foi submetido a uma tomografia computadorizada na admissão e classificado pela Escala de Coma de Glasgow, sendo a lesão cerebral classificada em grave (<9), moderada (9-12) ou leve (> 12). Aqueles cujos pais ou responsáveis concordaram em participar e apresentavam a forma leve de trauma cranioencefálico foram incluídos no estudo e convidados a realizar uma avaliação neuroendocrinológica. Resultados: Sessenta e oito crianças foram internadas com traumatismo cranioencefálico e 21 concordaram em participar. Cinco pacientes não realizaram os exames de sangue e urina, dois tinham a forma moderada e um tinha a forma grave de trauma cranioencefálico, sendo excluídos da análise.