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- Title
Central adrenal insufficiency following traumatic brain injury: a missed diagnosis in the critically injured.
- Authors
Fan, Eileen; Chanoine, Jean-Pierre; Skippen, Peter; Sargent, Michael; Cochrane, David
- 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.
- Subjects
HYPOPITUITARISM; BRAIN injuries; PATIENTS; ADRENAL insufficiency; HYDROCORTISONE; ADRENAL cortex
- Publication
Child's Nervous System, 2017, Vol 33, Issue 12, p2205
- ISSN
0256-7040
- Publication type
Article
- DOI
10.1007/s00381-017-3536-5