Kelly D F, Gonzalo I T, Cohan P, Berman N, Swerdloff R, Wang C
Division of Neurosurgery, University of California at Los Angeles, 90095-7039, USA.
J Neurosurg. 2000 Nov;93(5):743-52. doi: 10.3171/jns.2000.93.5.0743.
Recognition of pituitary hormonal insufficiencies after head injury and aneurysmal subarachnoid hemorrhage (SAH) may be important, especially given that hypopituitarism-related neurobehavioral problems are typically alleviated by hormone replacement. In this prospective study the authors sought to determine the rate and risk factors of pituitary dysfunction after head injury and SAH in patients at least 3 months after insult.
Patients underwent dynamic anterior and posterior pituitary function testing. Results of the tests were compared with those of 18 age-, sex-, and body mass index-matched healthy volunteers. The 22 head-injured patients included 18 men and four women (mean age 28+/-10 years at the time of injury) with initial Glasgow Coma Scale (GCS) scores of 3 to 15. Eight patients (36.4%) had a subnormal response in at least one hormonal axis. Four were growth hormone (GH) deficient. Five patients (four men, all with normal testosterone levels, and one woman with a low estradiol level) exhibited an inadequate gonadotroph response. One patient had both GH and thyrotroph deficiency and another had both GH deficiency and borderline cortisol deficiency. At the time of injury, all eight patients with pituitary dysfunction had an initial GCS score of 10 or less and, compared with the 14 patients without dysfunction, were more likely to have had diffuse swelling, seen on initial computerized tomography scans (p < 0.05), and to have sustained a hypotensive or hypoxic insult (p = 0.07). Of two patients with SAH who were studied (Hunt and Hess Grade IV) both had GH deficiency.
From this preliminary study, some degree of hypopituitarism appears to occur in approximately 40% of patients with moderate or severe head injury, with GH and gonadotroph deficiencies being most common. A high degree of injury severity and secondary cerebral insults are likely risk factors for hypopituitarism. Pituitary dysfunction also occurs in patients with poor-grade aneurysms. Postacute pituitary function testing may be warranted in most patients with moderate or severe head injury, particularly those with diffuse brain swelling and those sustaining hypotensive or hypoxic insults. The neurobehavioral effects of GH replacement in patients suffering from head injury or SAH warrant further study.
认识头部受伤和动脉瘤性蛛网膜下腔出血（SAH）后的垂体激素不足可能很重要，特别是考虑到垂体功能减退相关的神经行为问题通常可通过激素替代得到缓解。在这项前瞻性研究中，作者试图确定受伤后至少3个月的患者头部受伤和SAH后垂体功能障碍的发生率及危险因素。
患者接受了垂体前叶和后叶功能的动态测试。将测试结果与18名年龄、性别和体重指数相匹配的健康志愿者的结果进行比较。22名头部受伤患者包括18名男性和4名女性（受伤时平均年龄28±10岁），初始格拉斯哥昏迷量表（GCS）评分为3至15分。8名患者（36.4%）至少在一个激素轴上有异常反应。4名患者生长激素（GH）缺乏。5名患者（4名男性，睾酮水平均正常，1名女性雌二醇水平低）促性腺激素反应不足。1名患者同时有GH和促甲状腺激素缺乏，另1名患者有GH缺乏和临界皮质醇缺乏。受伤时，所有8名垂体功能障碍患者的初始GCS评分为10分或更低，与14名无功能障碍的患者相比，更有可能在初始计算机断层扫描中出现弥漫性肿胀（p<0.05），并且更有可能遭受低血压或低氧损伤（p = 0.07）。在研究的2名SAH患者（Hunt和Hess分级为IV级）中，两人均有GH缺乏。
从这项初步研究来看，约40%的中重度头部受伤患者似乎会出现某种程度的垂体功能减退，其中GH和促性腺激素缺乏最为常见。损伤严重程度高和继发性脑损伤可能是垂体功能减退的危险因素。垂体功能障碍也发生在低级别动脉瘤患者中。大多数中重度头部受伤患者，特别是那些有弥漫性脑肿胀以及遭受低血压或低氧损伤的患者可能需要进行急性后期垂体功能测试。头部受伤或SAH患者中GH替代的神经行为效应值得进一步研究。
