Eileen Fan1, Peter W Skippen2, Michael A Sargent3, David D Cochrane4, Jean-Pierre Chanoine1. 1. Endocrinology and Diabetes Unit, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. 2. Pediatric Intensive Care Unit, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. 3. Department of Radiology, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. 4. Division of Neurosurgery, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. jchanoine@cw.bc.ca.
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.
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.
Entities:
Keywords:
Adrenal cortex function tests; Brain injury; Central adrenal insufficiency; Hydrocortisone; Hypopituitarism; Pediatrics
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