Schwarz S, Schwab S, Klinga K, Maser-Gluth C, Bettendorf M
Department of Neurology, Klinikum Mannheim of the University of Heidelberg, Mannheim, Germany.
J Neurol Neurosurg Psychiatry. 2003 Jun;74(6):725-7. doi: 10.1136/jnnp.74.6.725.
To evaluate neuroendocrine changes in critical care patients with acute space occupying hemispheric stroke.
22 patients with acute space occupying hemispheric stroke were studied (mean age 57.7 years; five women, 17 men). Plasma levels of prolactin, thyrotropin (TSH), total thyroxine (T4), free thyroxine (FT4), and total triiodothyronine (T3) were measured on admission and thereafter on days 3, 5, 7, and 9. Cortisol and ACTH levels were analysed at 8.00, 16.00, and 24.00 hours each day. A TRH stimulation test with measurements of TSH and prolactin was done on day 3.
Nine patients underwent decompressive craniectomy and nine were treated with moderate hypothermia. All patients received vasopressor drugs because of arterial hypotension. Plasma ACTH and cortisol values were abnormally low despite systemic hypotension and acute systemic illness, and remained low throughout the observation period. The diurnal rhythm of cortisol was not preserved. Prolactin levels increased during the observation period, and were well above normal on day 9. Thyroid function was slightly suppressed until day 7. TRH stimulation of plasma TSH and prolactin was low.
Patients with an acute space occupying cerebral infarct show profound neuroendocrine changes. The central regulation of adrenal and thyroid function and prolactin release is impaired, which may compromise the clinical course of affected patients and have implications for therapeutic management.
评估急性占位性半球卒中重症监护患者的神经内分泌变化。
对22例急性占位性半球卒中患者进行研究（平均年龄57.7岁；女性5例，男性17例）。入院时及之后第3、5、7和9天测量血浆催乳素、促甲状腺激素（TSH）、总甲状腺素（T4）、游离甲状腺素（FT4）和总三碘甲状腺原氨酸（T3）水平。每天8点、16点和24点分析皮质醇和促肾上腺皮质激素（ACTH）水平。在第3天进行促甲状腺激素释放激素（TRH）刺激试验并测量TSH和催乳素。
9例患者接受了去骨瓣减压术，9例接受了亚低温治疗。所有患者因动脉低血压均接受了血管升压药物治疗。尽管存在系统性低血压和急性全身性疾病，但血浆ACTH和皮质醇值异常低，且在整个观察期内均保持较低水平。皮质醇的昼夜节律未得到维持。催乳素水平在观察期内升高，在第9天远高于正常水平。甲状腺功能在第7天前略有抑制。TRH对血浆TSH和催乳素的刺激作用较低。
急性占位性脑梗死患者表现出深刻的神经内分泌变化。肾上腺和甲状腺功能以及催乳素释放的中枢调节受损，这可能会影响受影响患者的临床病程，并对治疗管理产生影响。
