Endocrinologic dysfunction common among CNS infection survivors

Children who survived central nervous system (CNS) infections experience many endocrinologic imbalances, according to a study. Of these infections, meningitis poses the highest risk of subsequent endocrinopathies, particularly short stature.

“Encephalitis and cerebral abscesses are rarely associated with subsequent endocrinopathies and generally cause endocrine disorders only in the presence of anatomical alterations of the hypothalamic-pituitary axis,” the researchers said.

Eighty participants (median age 7.4 years) were enrolled in the study. Of these, 53 had a prior CNS infection and 27 were healthy controls. Thirteen patients had endocrinologic alterations: eight in those who had meningitis, four in encephalitis survivors, and one in those with a cerebral abscess. [Pediatr Infec Dis J 2025;44:310-317]

Compared with healthy controls, those with prior CNS infections were shorter (p=0.027), while patients who had meningitis were at greater risk of developing epilepsy (p=0.01), neurosensory disabilities (p=0.034), and the need for ventriculoperitoneal shunt insertion (p=0.006).

In addition, patients who had bacterial CNS infections were more likely to have neurosensory and endocrine dysfunctions than those with viral or other infections.

Hormone levels also significantly differed between previously infected children and healthy controls, particularly in TSH (p<0.001), ACTH (p<0.001), and cortisol (p=0.019). Moreover, patients with a history of CNS infection had markedly lower IGF-1 levels, both in absolute terms and when adjusted for age and sex (p<0.001).

“The regression analysis suggested that the reduction in IGF-1 was more pronounced the earlier the CNS infection occurred, irrespective of infection type,” the researchers said.

Lower height

The growth rate of children could be adversely affected by previous bacterial infections, particularly those that were severe. Survivors of infections, such as meningitis, often demonstrate nutritional deficits and metabolic problems that may hinder growth relative to their healthy counterparts. [Pediatr Res 2022;91:267-269; JAMA Netw Open 2021;4:e2116919]

Nutritional impairment then affects IGF-1 levels, resulting in reduced growth hormone action and a likely decrease in growth velocity. Short stature can also be driven by a general compromise of the child’s overall condition due to prolonged hospital stays and physical limitations because of postinfectious neurological alterations. [Ann Biol Clin (Paris) 1995;53:527-538; BMC Pediatr 2022;22:140]

Organic conditions, such as hydrocephalus onset and postinflammatory changes affecting the hypothalamic-pituitary region, may also contribute to the slow growth rate of children with prior CNS infection. [BMC Endocr Disord 2014;14:80]

“These data highlight the importance of including long-term outcomes in any interventional study of children with CNS infections,” they noted.

This prospective monocentric observational study was carried out at the Fondazione Policlinico Universitario Agostino Gemelli in Rome, Italy.

The researchers included patients with a history of CNS infections, who had been admitted to various paediatric departments of the hospital. They selected the participants based on a coded diagnosis of CNS infection and if the patients completed their follow-up at the Pediatric Endocrinology Day Hospital after October 2019.