Einaudi Silvia, Bondone Claudia
Department of Pediatric Endocrinology, Regina Margherita Hospital, Turin, Italy.
Curr Opin Pediatr. 2007 Aug;19(4):465-70. doi: 10.1097/MOP.0b013e3281ab6eeb.
Endocrine dysfunctions have been increasingly recognized following traumatic brain injury. Ever more numerous studies on acute head-injured adults have also raised concern about this risk in children and adolescents who have experienced head injury. The current review of the pediatric literature summarizes recent findings on acute-phase dysfunction and traumatic brain injury-associated hypopituitarism.
The pathophysiologic mechanisms underlying acute-phase hyponatremic and hypernatremic disorders have been elucidated. Prospective studies on traumatic brain injury-associated hypopituitarism in pediatric patients are ongoing and preliminary data are available.
Traumatic brain injury, a 'silent epidemic' that carries a considerable burden of disabilities, leads to a variety of endocrine dysfunctions in 28-69% of adult acute head-injured patients. In the acute posttraumatic phase, adrenal insufficiency and electrolyte disorders are critical conditions. Neurosurgical patients, particularly those prone to neurological damage, require prompt diagnosis. Hypopituitarism may be diagnosed months or years after a traumatic brain injury event. Since growth hormone and gonadotropin secretion are most frequently compromised, careful follow-up of growth and pubertal development is mandatory in children hospitalized for traumatic brain injury.
创伤性脑损伤后内分泌功能障碍越来越受到关注。针对成年急性颅脑损伤患者的研究日益增多，这也引发了人们对经历过头部损伤的儿童和青少年内分泌功能障碍风险的担忧。本儿科文献综述总结了急性期功能障碍和创伤性脑损伤相关垂体功能减退的最新研究结果。
已阐明急性期低钠血症和高钠血症疾病的病理生理机制。关于儿科患者创伤性脑损伤相关垂体功能减退的前瞻性研究正在进行中，已有初步数据。
创伤性脑损伤是一种“无声的流行病”，造成了相当大的残疾负担，导致28%至69%的成年急性颅脑损伤患者出现各种内分泌功能障碍。在创伤后急性期，肾上腺功能不全和电解质紊乱是关键情况。神经外科患者，尤其是那些容易出现神经损伤的患者，需要及时诊断。垂体功能减退可能在创伤性脑损伤事件发生数月或数年之后才被诊断出来。由于生长激素和促性腺激素分泌最常受到影响，因此对于因创伤性脑损伤住院的儿童，必须仔细跟踪其生长和青春期发育情况。
