Lieberman S A, Oberoi A L, Gilkison C R, Masel B E, Urban R J
Transition Learning Community (B.E.M.) and Departments of Internal Medicine (S.A.L., A.L.O., C.R.G., R.J.U.) and Neurology (B.E.M.), University of Texas Medical Branch, Galveston, Texas 77555.
J Clin Endocrinol Metab. 2001 Jun;86(6):2752-6. doi: 10.1210/jcem.86.6.7592.
Although hypopituitarism is a known complication of head injury, it may be underrecognized due to its subtle clinical manifestations. The nonspecific symptoms may be masked by and may contribute to the physical and psychological sequelae of brain trauma. This study examines the prevalence of neuroendocrine abnormalities in patients rehabilitating from traumatic brain injury. Seventy adults (mean age, 31.5 +/- 1.1 yr; range, 18--58; 46 men and 24 women) with traumatic brain injury an average of 49 +/- 8 months before the study (median, 13 months) underwent a series of standard endocrine tests, including serum levels of TSH, free T(4), insulin-like growth factor I, PRL, testosterone (males), and cosyntropin stimulation. Abnormal results of these tests were followed by dynamic tests of gonadotropin, TSH, and GH secretion. Glucagon stimulation testing in 48 subjects revealed GH deficiency (peak, <3 microg/L) in 14.6%. Free T(4) (n = 6; 8.6%), TSH (n = 7; 10%), or both (n = 2; 2.9%) were low in 21.7%, whereas 87% had both TSH and free T(4) below the midnormal level. Basal morning cortisol was below normal in 45.7% of subjects, whereas cosyntropin-stimulated levels were insufficient (peak, <500 nmol/L) in 7.1%. Hypogonadism and hyperprolactinemia were uncommon. In summary, pituitary hormone deficiencies were identified in a substantial proportion of patients with previous brain injury. GH deficiency, found in 15% by glucagon stimulation testing, may compound the physical and psychological complications of traumatic brain injury and interfere with rehabilitation.
虽然垂体功能减退是头部损伤已知的并发症，但由于其临床表现隐匿，可能未得到充分认识。非特异性症状可能被脑外伤的身体和心理后遗症所掩盖，也可能是其一部分。本研究调查了创伤性脑损伤康复患者中神经内分泌异常的发生率。70名成年人（平均年龄31.5±1.1岁；范围18 - 58岁；46名男性和24名女性）在研究前平均49±8个月（中位数13个月）有创伤性脑损伤，接受了一系列标准内分泌检查，包括血清促甲状腺激素（TSH）、游离T4、胰岛素样生长因子I、催乳素（PRL）、睾酮（男性）水平以及促肾上腺皮质激素刺激试验。这些检查结果异常后，进一步进行了促性腺激素、TSH和生长激素（GH）分泌的动态试验。48名受试者的胰高血糖素刺激试验显示，14.6%存在GH缺乏（峰值<3μg/L）。21.7%的患者游离T4（n = 6；8.6%）、TSH（n = 7；10%）或两者（n = 2；2.9%）水平偏低，而87%的患者TSH和游离T4均低于正常范围中位数水平。45.7%的受试者基础晨起皮质醇水平低于正常，而促肾上腺皮质激素刺激后的水平不足（峰值<500nmol/L）的占7.1%。性腺功能减退和高催乳素血症并不常见。总之，相当一部分既往有脑损伤的患者存在垂体激素缺乏。通过胰高血糖素刺激试验发现15%的患者存在GH缺乏，这可能会加重创伤性脑损伤的身体和心理并发症，并干扰康复。
