Central adrenal insufficiency following traumatic brain injury: a missed diagnosis in the critically injured

• Published in: Child's nervous system 2017-12, Vol.33 (12), p.2205-2207
• Main Authors: Fan, Eileen, Skippen, Peter W., Sargent, Michael A., Cochrane, David D., Chanoine, Jean-Pierre
• Format: Article
• Language: English
• Subjects: Adrenal Insufficiency - diagnosis; Adrenal Insufficiency - drug therapy; Adrenal Insufficiency - etiology; Adrenocorticotropic Hormone - administration & dosage; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - drug therapy; Case Report; Child; Critical Illness - therapy; Diagnostic Errors; Human Growth Hormone - administration & dosage; Humans; Male; Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Testosterone - administration & dosage
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-017-3536-5

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.