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

Fan E, et al. Childs Nerv Syst. 2017.

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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.

PMID 28721596 [PubMed – as supplied by publisher]
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Author: tbihealing

Sean Dudas is a California native and remains active and interested in many corners of life. In November of 2015, Sean suffered a moderate traumatic brain injury from a fall; his life since has been solely devoted to the topic of this blog - TBI and other forms of acquired brain injury. With his passions and life as he imagined it to be on an indeterminate hold during his rehabilitation and recovery, he began this blog and a TBI health advocacy group. Through uniform rules of professional responsibility and ethics, he hopes the health advocate profession may be an affordable adjunct to the team needed by every brain injured person and those caring for them. He hopes that this blog will continue educating and supporting survivors of brain injury, their caregivers, and anyone interested in this devastating medical sojourn, alongside the discovery of a new self and a meaningful life outside the treatment environment. Sean is active in supporting mental health and suicide crisis support, various manifestations of trauma in children and adults, and is a Doctor of Law with a focus on health and science law. He is also an athlete, poet, writer, and nature enthusiast.

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