Banca de DEFESA: Eliane Cespedes Paes Huard

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : Eliane Cespedes Paes Huard
DATE: 22/01/2024
TIME: 14:00
LOCAL: Sala de Reuniões do Laboratório Interdisciplinar de Biociências – Faculdade de Medicina da Universid
TITLE:

Long-term follow-up of neuroimaging changes in pituitary morphology in children and adolescents after traumatic brain injury

KEY WORDS:

Cranioencephalic trauma; pediatrics; neuroimage; pituitary; morphology.

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction. Traumatic brain injury (TBI) is associated with a potential risk of triggering anatomical and/or functional alterations in various brain structures. Among the possible consequences of moderate to severe TBI is hypothalamic-pituitary dysfunction, which can be transient or permanent and manifest itself in the short, medium, or long term. We found no studies in the literature evaluating the impact of TBI on pituitary morphology over time in the post-trauma period.

Objectives. To carry out a longitudinal study of pituitary morphology (dimensions of its axes and volume) in children and adolescents who suffered a TBI and were followed up at the SARAH Network of Rehabilitation Hospitals; to recognize the frequency of structural pituitary lesions identified in this group; to assess whether there is a correlation between age at the time of the trauma and the sex of the patient with the pattern of changes in pituitary morphology over the years after the TBI. Methods. This is a retrospective longitudinal study of a cohort of children and adolescents who suffered a TBI before the age of 16 years and 11 months, treated in the Post-TBI Neurorehabilitation Program at the SARAH Brasília Unit and the SARAH International Neuroscience and Rehabilitation Center, Brasília (DF). Magnetic Resonance Imaging (MRI) scans of the brain/pituitary gland of children and adolescents, carried out between 2009 and 2021, were analyzed. The three pituitary dimensions (coronal height, coronal width, and sagittal width) and the respective volumes of the glands were obtained by analyzing the images in midsagittal and coronal views and performed by the same trained observer. The patients were grouped according to gender and the time after the stroke in which the MRIs were performed into: group 1 (G1: images taken during the first year after the stroke), group 2 (G2: images taken between 1 and £ 2 years after the stroke), group 3 (G3: images taken between 2 and £ 3 years post-CT), group 4 (G4: images taken between 3 and £ 4 years postCT), group 5 (images taken between 4 and £ 5 years post-CT) and group 6 (G6: images taken more than 5 years post-CT). The patients' pituitary dimensions and volumes were analyzed, and correlated according to the clinical variables gender, age at which the TBI occurred and time post-TBI. Results. A total of 78 patients were assessed, with a higher proportion of male TBI victims (n = 47, p = 0.01). The median age of the total group at the time of the TBI was 5.8 years (range 0.2 to 13.7 years), with no difference between the sexes (p=0.749). 152 pituitary MRI images were analyzed, with some patients having more than one sequential image analyzed. The time between the TBI and the pituitary MRI ranged from 0.1 to 15.8 years, with the following distribution: G1: n = 41, median 0.5 years; G2: n = 28, median 1.6 years; G3: n = 16, median 2.5 years; G4: n = 18, median 3.8 years; G4: n = 16, median 4.6 years; G6: n = 33, median 8 years. Alterations in pituitary morphology (decreased pituitary volume) were found in 23% of the images, corresponding to 32% of the patients (72% female), all of which corresponded to severe TBI, with no difference between the sexes. A U-shaped curve was observed when assessing the behavior of pituitary volume over time after TBI. The data showed a progressive decrease in the median of these values from the first to the third year after TBI, followed by a progressive increase from that point onwards (p = 0.00033). The pituitary dimensions coronal height and coronal width also behaved similarly to the volume over time after the TBI (p = 0.00004 and p = 0.0.00003, respectively). There was no correlation between age at TBI and severity of impairment of pituitary morphology over the post-TBI period. Conclusion. In the group under this study, there was a higher proportion of male TBI victims. There was no difference in age at TBI in relation to gender. Around a third of the patients showed changes in pituitary morphology over the follow-up period. The total group showed a nadir in pituitary volume between 2 and 4 years post-TBI, followed by recovery. There was no influence of gender or age at TBI on the evolution of pituitary morphology over the years after TBI.

COMMITTEE MEMBERS:
Externa à Instituição - KATIA TORRES BATISTA - DAHER
Presidente - 2189235 - LUIZ CLAUDIO GONCALVES DE CASTRO
Externa ao Programa - 1550653 - NEYSA APARECIDA TINOCO REGATTIERI - nullExterno à Instituição - Vinícius Viana Abreu Montanaro - SARAH