Neurodisability and risk of hypopituitarism: to screen or not to screen?

Children with neurodisabilities are a very diverse group. Endocrine dysfunction is not always anticipated but screening for potential risk of developing hypopituitarism is important in clinical practice. Hypopituitarism in children with neurodisability can be part of an underlying congenital syndrome or acquired. Diagnosis of hypopituitarism on clinical grounds is challenging in some cases. Accurate growth monitoring is more difficult in this group due to orthopaedic factors, such as spasticity, spinal deformities such as scoliosis or joint contractures. Moreover, the signs and symptoms of hypopituitarism may mimic those associated with their neurodisability itself. These can overlap or exacerbate each other and the onset is sometimes insidious. In this review, we focus on the pituitary hormone deficiencies most commonly associated with neurodisability and offer practical advice for healthcare professionals. We explain when it is important to consider further pituitary function investigations and when and why referral to a paediatric endocrinologist is required.