Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward

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-t...

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Main Authors: Alina Nico West, Alicia M. Diaz-Thomas, Nadeem I. Shafi
Format: Article
Language:English
Published: Frontiers Media S.A. 2020-11-01
Series:Frontiers in Neurology
Subjects:
TBI
Online Access:https://www.frontiersin.org/articles/10.3389/fneur.2020.551923/full
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spelling doaj-6af42742f4974be1b4b16bc260c1d9782020-12-08T08:42:57ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-11-011110.3389/fneur.2020.551923551923Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path ForwardAlina Nico West0Alicia M. Diaz-Thomas1Nadeem I. Shafi2Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesDivision of Endocrinology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesDivision of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United StatesNeuroendocrine 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.https://www.frontiersin.org/articles/10.3389/fneur.2020.551923/fullPediatric hypopituitarismneurotraumasexual dimorphismneuroendocrine dysfunctionTBIneuropsychology
collection DOAJ
language English
format Article
sources DOAJ
author Alina Nico West
Alicia M. Diaz-Thomas
Nadeem I. Shafi
spellingShingle Alina Nico West
Alicia M. Diaz-Thomas
Nadeem I. Shafi
Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
Frontiers in Neurology
Pediatric hypopituitarism
neurotrauma
sexual dimorphism
neuroendocrine dysfunction
TBI
neuropsychology
author_facet Alina Nico West
Alicia M. Diaz-Thomas
Nadeem I. Shafi
author_sort Alina Nico West
title Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
title_short Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
title_full Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
title_fullStr Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
title_full_unstemmed Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward
title_sort evidence limitations in determining sexually dimorphic outcomes in pediatric post-traumatic hypopituitarism and the path forward
publisher Frontiers Media S.A.
series Frontiers in Neurology
issn 1664-2295
publishDate 2020-11-01
description 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.
topic Pediatric hypopituitarism
neurotrauma
sexual dimorphism
neuroendocrine dysfunction
TBI
neuropsychology
url https://www.frontiersin.org/articles/10.3389/fneur.2020.551923/full
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