The prevalence of endocrine dysfunction in head injured children and adolescents and its impact on health, cognition, emotional/behavioural status and health related quality of life (Kid’s Head Injury Neuro-Endocrine Study, “KHINES”)

  • Nik Daskas

Student thesis: Doctoral ThesisDoctor of Medicine (MD)

Abstract

Traumatic Brain Injury (TBI) is a major cause of death and acquired disability including endocrine dysfunction but paediatric data are sparse. KHINES investigated in a well-characterised prospective cohort of TBI adolescents the endocrine status and relationship to outcome measures of cognition, fatigue and Health-Related Quality of Life (HRQL).
Seventy-two participants (age 10-26y, time from TBI 6-11y) completed the study. Participants were allocated in 3 groups: Group 1 [control group], Group 2 [mild TBI] and Group 3 [moderate/severe TBI]. Participants in Group 3 completed detailed endocrine assessments. Salivary cortisol, cognitive, psychological, HRQL assessment and brain imaging (MRI) was undertaken in all groups.
There were no auxological differences between groups (height, weight, BMI, body fat percentage) or cases of precocious puberty or diabetes insipidus. One female had primary amenorrhea and GH deficiency. Peak stimulated GH response was low in 7/25 tests but only in 1/22 overnight profiles. Spontaneous -but not stimulated- GH secretion correlated with IGF1 levels. Cortisol response was suboptimal in 2/25. Peak spontaneous cortisol was low in 9/22 profiles, stimulated levels were normal in 7 of these. Spontaneous and stimulated cortisol levels correlated strongly. Salivary cortisol analysis did not demonstrate differences between groups. Verbal IQ was lower in the mod/sev TBI group who also showed difficulties with both externalising, internalising behaviour and working memory. Depression and fatigue were prevalent in up to half of TBI participants. HRQL was lower in TBI participants mainly because of lower psychosocial scores. Neuroimaging did not demonstrate any structural pituitary abnormality. Voxel based morphometry showed reduced grey matter and right hippocampus volume in the mod/sev TBI group.
KHINES has demonstrated that endocrine dysfunction after childhood TBI is less frequent than previously reported but should still be considered. GH stimulation tests should be reserved for patients with low IGF1 or clinical evidence of other hormone deficiency.
Date of Award25 Sep 2018
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorLiz Crowne (Supervisor), Stafford L Lightman (Supervisor) & Peta Sharples (Supervisor)

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