Acquired growth hormone deficiency and hypogonadotropic hypogonadism in a subject with repeated head trauma, or Tintin goes to the neurologist

MRI Findings of Pituitary Gland in Growth Hormone-Deficient Children and Their Correlation with Growth Hormone Peak during Growth Hormone Stimulation Tests

This study aims to explore the magnetic resonance imaging (MRI) findings of the pituitary gland (PG) in children with growth hormone deficiency (GHD) and their correlation with the growth hormone (GH) peak during clinical GH stimulation tests. Sixty-one children with GHD diagnosed and treated between December 2018 and December 2021 were retrospectively analyzed in terms of clinical and pituitary morphological MRI data. MRI measurements of various diameters of the adenohypophysis (AH) were obtained to analyze the differences of the measured values in different genders and age groups, as well as their relationship with the GH peak in GH stimulation tests. Among the 61 children with GHD, the superior PG margin was protuberant in 2 cases, flat in 13 cases, and concave in 46 cases. The three age groups showed similar pituitary morphology and stalk (P > 0.05). On T1-weighted images, the proportion of isointensity was lower while the proportion of slightly-low signal intensity was higher in the anterior pituitary gland (APG) of children aged >10 compared with those aged 7–10. The comparison of AH linear parameters and GH peak values of male patients among different age groups showed that the anteroposterior (sagittal) diameter of AH and GH peak were the highest in the >10-year-old group and the lowest in the ≤6-year-old group, with those of the 7–10-year-old group in between (P < 0.05). In females, the anteroposterior (sagittal) diameter and GH peak were higher in the 7–10-year-old group and >10-year-old group compared with the ≤6-year-old group (P < 0.05). The MRI coronal and sagittal heights of PG in children with GHD were positively correlated with the GH peak value. In conclusion, in GHD patients, the coronal and sagittal heights as well as the coronal width of AH do not change with sex or age, but the coronal and sagittal heights of PG are positively correlated with the GH peak of GH stimulation tests, which has high application value in the diagnosis of children with GHD.

[Perineal pain in Tintin adventures]

AIMS

To analyze the determinants and severity of perineal pain in the adventures of Tintin and Snowy.

MATERIAL AND METHODS

All 23 adventures of Tintin and Snowy (Hergé, Moulinsart Ed.) were reviewed in order to determine the presence, causes and severity of perineal pain (PP) observed in the various heroes of this comic book. Several parameters were studied: the cause which could be either accidental or voluntary; the type of patient (good guys-bad guys); the hero concerned (Tintin, Captain Haddock, Thompson and Thomson, Snowy, Professor Calculus …); the duration of the pain (by the number of boxes where the subject was represented suffering from such pains); finally, the severity of these pains, by the number of stars or signs designating the region and stereotyping the importance of the pain. The Student and Chi² tests were used to analyze these different qualitative and quantitative variables.

RESULTS

Five hundred and one traumas were found in the adventures of Tintin and Snowy, including 47 PP, 9.4% of cases compared to 299 head traumas (60% of cases). Six albums out of the 23 did not report any PP. PPs are usually traumatic either by a fall (68%) or by direct trauma (kick to the back 6%, spanking 4%) much more exceptionally by a bite (2 cases), a burn (2 cases), needles or arrows inserted in the bottom (5 cases) and a bullet wound (1 case). Tintin is the most concerned (19%) with Captain Haddock (23%), followed by Snowy (15%). The bad guys and the good guys don't share equally the perineal pain since the good guys are forgivably more exposed (79% vs. 21%). There is no correlation between head trauma and PP (r²=0.117). The severity index for PP is 5.21 with a mean duration of 3.01 vs. 6.88 for severity and 3.2 for duration for head trauma, a highly significant difference in the Student test (P=0.00259). The total number of traumas per album progressively decreases over the albums (r²=0.3111) with, for example, 38 for the first album (Tintin and the Soviets) and 4 for the last one (Tintin and the Picaros). This decrease in trauma is clearer for cephalic trauma (r²=0.1436) than for PP (r²=0.2189).

CONCLUSION

The frequency of traumatic PP in Tintin's adventures is important and is second only to head injuries. This frequency of PP traumas is undoubtedly linked to the hectic and adventurous life of Tintin and his acolytes exposed in all circumstances to all kinds of direct or indirect injuries. Future studies will have to specify the risk of after-effects and the psychological impact of PPs on the heroes concerned.

LEVEL OF PROOF

4.

Concussions and Repercussions

In their Perspective, Donald A. Redelmeier and Sheharyar Raza discuss the significance of Seena Fazel and colleagues' longitudinal study of traumatic brain injury (TBI)-associated outcomes.

Tintin's travel traumas: Health issues affecting the intrepid globetrotter

BACKGROUND

Despite the highly hazardous life-style led by comic book characters such as Tintin, we are unaware of any previous systematic description of the challenges and health impairments faced by Tintin in the course of his adventures.

METHODS

We evaluated the spectrum of health impairments (HIs) that Tintin sustained in his 23 adventures as well as their causes, consequences, and relation to travel. We diagnosed Tintin's HIs according to descriptive terms in the text. We then classified HIs as traumatic and non-traumatic, and distinguished between intentional (those perpetrated by others) and unintentional events.

RESULTS

We found 236 events leading to 244 HIs, 13 kidnappings, six hospitalisations and two surgical procedures. There was a median of 8 HIs/adventure (range 1-30/adventure). The mean number of HIs per adventure was much greater before 1945 than subsequently (14.9 vs. 6.1; P=0.002), which was also true of the number of kidnappings (11 vs. 2; P=0.001). Of the 244 HIs, there were 191 cases of trauma (78.3%) and 53 non-traumatic problems (21.7%). The most common form of trauma was concussion (62%) whereas the most common forms of non-traumatic problems were sleep problems (15.1%), depression/anxiety (13%), and gas or chloroform poisoning (13%). Overall, we found 46 losses of consciousness (LoC), including 29 traumatic and 17 non-traumatic LoCs. Of the 236 events, there were 69 (29%) perpetrated by others against Tintin (including 55 homicide attempts), and 167 (71%) events that were not (including 69 events related to Tintin's actions).

CONCLUSION

Tintin's almost superhuman qualities, a luxury afforded him by his fictional status, make him highly resistant to trauma. He is also not susceptible to the usual travel-related illnesses but is easily influenced by his friends and Snowy, his faithful hound.

The endocrine quiz

With the recent explosion in endocrine conferences, audience fatigue has set in and conference planners are now looking at newer pedagogic methods to revive the interest of audiences in these conferences. The endocrine quiz has finally come of vogue and is increasingly becoming one of the most popular attractions of any ranking endocrine conference. The endocrine quiz has a large and varied palette and draws questions from religious scriptures, history, literature, current affairs, sports, movies and basic and paramedical sciences. The more we delve into the quizzable aspects of endocrinology, the more we realize that endocrinology is ubiquitous and there is no sphere in human life untouched by endocrine disorders. Be it epic characters like Kumbhakarna and Bheema, fiction characters like Tintin or Orphan Annie, sportspersons like Gail Devers or heads of state like George Bush Sr and Boris Yeltsin, all have contributed to the melting pot of endocrine quizzing. Adding further grist to the endocrine mill are the Nobel prizes, with their attendant anecdotes and controversies. Step into this world of endocrine quizzing to have an up close and personal look at the diverse facets of this subject.

Nodding and napping in medical lectures: an instructive systematic review

A comprehensive, international systematic review, spanning more than 100 years of data collection, suggests that soporific lectures at medical meetings are common, annoying and persistent. Low lights and boring material are prominent risk factors for nodding off during presentations. Extreme remedial measures are warranted.

Hypopituitarism following traumatic brain injury

Recent studies have demonstrated that hypopituitarism, and in particular growth hormone (GH) deficiency, is common among survivors of traumatic brain injury (TBI) tested several months or years following head trauma. In addition, it has been shown that post-traumatic neuroendocrine abnormalities occur early and with high frequency. These findings may have significant implications for the recovery and rehabilitation of patients with TBI. Although data emerging after 2000 demonstrate the relevance of the problem, in general there is a lack of awareness in the medical community about the incidence and clinical repercussions of the pathology. Most, but not all, head trauma associated with hypopituitarism is the result of motor accidents. The subjects at risk are those who have suffered moderate-to severe head trauma although mild intensity trauma may precede hypopituitarism also. Particular attention should be paid to this problem in children and adolescents. Onset of pituitary deficits can evolve over years following injury. For the assessment of the GH-IGF axis in TBI patients, plasma IGF-I concentrations, plus dynamic GH testing is indicated. Some degree of hypopituitarism is found in 35-40% of TBI patients. Among multiple pituitary deficits, the most common ones were GHD and gonadotrophin deficiency. In most series 10-15% presented with severe GHD and 15% with partial GHD after stimulating GH secretion confirming that the most common isolated deficit is GHD. Psychometric evaluation together with neurocognitive testing shows variability of disability and the possibility that untreated TBI induced hypopituitarism contributes to the chronic neurobehavioral problems seen in many head-injured patients warrants consideration. Preliminary data, from small pilot, open-label studies show that subjects treated with GH experience significant improvements in concentration, memory, depression, anxiety and fatigue. In conclusion, pituitary failure can occur even in minor head injuries and is poorly recognized.