Abstract
Neuroendocrine dysfunction can occur as a consequence of traumatic brain injury (TBI), and disruptions to the hypothalamic-pituitary axis can be especially consequential to children. The purpose of our review is to summarize current literature relevant to studying sex differences in pediatric post-traumatic hypopituitarism (PTHP). Our understanding of incidence, time course, and impact is constrained by studies which are primarily small, are disadvantaged by significant methodological challenges, and have investigated limited temporal windows. Because hormonal changes underpin the basis of growth and development, the timing of injury and PTHP testing with respect to pubertal stage gains particular importance. Reciprocal relationships among neuroendocrine function, TBI, adverse childhood events, and physiological, psychological and cognitive sequelae are underconsidered influencers of sexually dimorphic outcomes. In light of the tremendous heterogeneity in this body of literature, we conclude with the common path upon which we must collectively arrive in order to make progress in understanding PTHP.
Highlights
The pituitary gland sits within the sella turcica, connected to the hypothalamus by the infundibulum and surrounded by a rich vascular web [1]
We initiated this review with the goal of describing sexual dimorphism in pediatric post-traumatic hypopituitarism (PTHP)
(4) A lack of guidelines for testing windows may result in missed diagnoses of transient and persistent PTHP as well as delayed intervention
Summary
The pituitary gland sits within the sella turcica, connected to the hypothalamus by the infundibulum and surrounded by a rich vascular web [1] It contributes to maintaining physiologic homeostasis and regulating processes of growth and development. We first describe how sex influences physical and cognitive development (section “Sexual Dimorphism in Physical and Cognitive Development”), which is followed by how outcomes after TBI vary according to sex (section “SexRelated Differences in Overall TBI Outcomes”) Together, these essentially serve as co-variates in the sexual dimorphism of PTHP. After demonstrating how the lack of prospective, sex-balanced, intentional studies hamper the ability to draw conclusions, we end by proposing a path forward (section “Conclusions and the Path Forward”) This path—if agreed upon and adopted in future investigations—would allow us to gain critical insights into the PTHP disorders
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