Ortiz J Bryce, Sukhina Alona, Balkan Baran, Harootunian Gevork, Adelson P David, Lewis Kara S, Oatman Oliver, Subbian Vignesh, Rowe Rachel K, Lifshitz Jonathan
Translational Neurotrauma Research Program, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.
Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.
Front Neurol. 2020 Jan 22;10:1410. doi: 10.3389/fneur.2019.01410. eCollection 2019.
Traumatic brain injury (TBI) in children can result in long-lasting social, cognitive, and neurological impairments. In adults, TBI can lead to endocrinopathies (endocrine system disorders), but this is infrequently reported in children. Untreated endocrinopathies can elevate risks of subsequent health issues, such that early detection in pediatric TBI survivors can initiate clinical interventions. To understand the risk of endocrinopathies following pediatric TBI, we identified patients who had experienced a TBI and subsequently developed a new-onset hypothalamic regulated endocrinopathy ( = 498). We hypothesized that pediatric patients who were diagnosed with a TBI were at higher risk of being diagnosed with a central endocrinopathy than those without a prior diagnosis of TBI. In our epidemiological assessment, we identified pediatric patients enrolled in the Arizona Health Care Cost Containment System (AHCCCS) from 2008 to 2014 who were diagnosed with one of 330 TBI International Classification of Diseases (ICD)-9 codes and subsequently diagnosed with one of 14 central endocrinopathy ICD-9 codes. Additionally, the ICD-9 code data from over 600,000 Arizona pediatric patients afforded an estimate of the incidence, prevalence, relative risk, odds ratio, and number needed to harm, regarding the development of a central endocrinopathy after sustaining a TBI in Arizona Medicaid pediatric patients. Children with a TBI diagnosis had 3.22 times the risk of a subsequent central endocrine diagnosis compared with the general population (±0.28). Pediatric AHCCCS patients with a central endocrine diagnosis had 3.2-fold higher odds of a history of a TBI diagnosis than those without an endocrine diagnosis (±0.29). Furthermore, the number of patients with a TBI diagnosis for one patient to receive a diagnosis of a central endocrine diagnosis was 151.2 (±6.12). Female subjects were more likely to present with a central endocrine diagnosis after a TBI diagnosis compared to male subjects (64.1 vs. 35.9%). These results are the first state-wide epidemiological study conducted to determine the risk of developing a hypothalamic-pituitary disorder after a TBI in the pediatric population. Our results contribute to a body of knowledge demonstrating a TBI etiology for idiopathic endocrine disorders, and thus advise physicians with regard to TBI follow-up care that includes preventive screening for endocrine disorders.
儿童创伤性脑损伤（TBI）可导致长期的社交、认知和神经功能障碍。在成人中，TBI可导致内分泌疾病（内分泌系统紊乱），但在儿童中这种情况鲜有报道。未经治疗的内分泌疾病会增加后续健康问题的风险，因此在儿科TBI幸存者中进行早期检测可以启动临床干预。为了了解儿科TBI后内分泌疾病的风险，我们确定了经历过TBI并随后出现新发下丘脑调节性内分泌疾病的患者（n = 498）。我们假设，被诊断为TBI的儿科患者比未事先诊断为TBI的患者被诊断为中枢性内分泌疾病的风险更高。在我们的流行病学评估中，我们确定了2008年至2014年在亚利桑那州医疗成本控制系统（AHCCCS）登记的儿科患者，他们被诊断患有330种TBI国际疾病分类（ICD）-9编码中的一种，随后又被诊断患有14种中枢性内分泌疾病ICD-9编码中的一种。此外，来自60多万名亚利桑那州儿科患者的ICD-9编码数据提供了关于亚利桑那州医疗补助儿科患者在遭受TBI后发生中枢性内分泌疾病的发病率、患病率、相对风险、比值比和伤害所需人数的估计。与普通人群相比，诊断为TBI的儿童随后发生中枢性内分泌疾病的风险高3.22倍（±0.28）。患有中枢性内分泌疾病诊断的儿科AHCCCS患者有TBI诊断史的几率比没有内分泌疾病诊断的患者高3.2倍（±0.29）。此外，一名患者接受中枢性内分泌疾病诊断所需的有TBI诊断的患者数量为151.2（±6.12）。与男性受试者相比，女性受试者在TBI诊断后更有可能出现中枢性内分泌疾病诊断（64.1%对35.9%）。这些结果是首次进行的全州范围的流行病学研究，以确定儿科人群在TBI后发生下丘脑-垂体疾病的风险。我们的结果有助于证明特发性内分泌疾病的TBI病因的知识体系，并因此为医生提供有关TBI后续护理的建议，其中包括对内分泌疾病的预防性筛查。
