Hypopituitarism secondary to pediatric traumatic brain injury – A need for active vigilance

Hypopituitarism, a known sequelae of pediatric traumatic brain injury (TBI), is often overlooked, especially in acute settings where more dynamic issues warrant the clinician’s attention. Pituitary dysfunction following pediatric TBI usually develops early and is often transient. However, a long-term follow-up is required to monitor the ongoing needs of hormonal replacement therapy as well as to identify the onset of new hormonal deficiencies, which can develop many years after the brain injury. This case describes the clinical course of an infant who suffered a fall and developed multiple skull fractures. The child required admission to intensive care and developed hypopituitarism (cortisol, thyroid, vasopressin, and growth hormone) secondary to severe TBI. The clinical (refractory shock and polyurea) and radiological red flags (empty sella) can assist in predicting the development of pituitary dysfunction in such cases.