Department of Endocrinology and Metabolic Diseases C4-R, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Endocrinol. 2010 Jan;162(1):11-8. doi: 10.1530/EJE-09-0601. Epub 2009 Sep 25.
Traumatic brain injury (TBI) has emerged as an important cause of hypopituitarism. However, considerable variations in the prevalence of hypopituitarism are reported. These can partly be explained by severity of trauma and timing of hormonal evaluation, but may also be dependent on endocrine tests and criteria used for diagnosis of hypopituitarism.
Systematic review of studies reporting prevalence of hypopituitarism in adults >or=1 year after TBI focusing on used (dynamic) tests and biochemical criteria.
We included data from 14 studies with a total of 931 patients. There was considerable variation in definition of hypopituitarism. Overall, reported prevalences of severe GH deficiency varied between 2 and 39%. Prevalences were 8-20% using the GHRH-arginine test (cutoff <9 microg/l), 11-39% using the glucagon test (cutoff 1-5 microg/l), 2% using the GHRH test (no cutoff), and 15-18% using the insulin tolerance test (ITT; cutoff <3 microg/l). Overall, the reported prevalence of secondary adrenal insufficiency had a broad range from 0 to 60%. This prevalence was 0-60% with basal cortisol (cutoff <220 or <440 nmol/l), 7-19% using the ACTH test, and 5% with the ITT as first test (cutoff <500 or <550 nmol/l). Secondary hypothyroidism was present in 0-19% (free thyroxine) or 5-15% (thyroid-releasing hormone stimulation). Secondary hypogonadism was present in 0-29%.
The reported variations in the prevalence rates of hypopituitarism after TBI are in part caused by differences in definitions, endocrine assessments of hypopituitarism, and confounding factors. These methodological issues prohibit simple generalizations of results of original studies on TBI-associated hypopituitarism in the perspective of meta-analyses or reviews.
颅脑损伤（TBI）已成为垂体功能减退症的一个重要原因。然而，垂体功能减退症的患病率有很大差异。这些差异部分可以用创伤的严重程度和激素评估的时间来解释，但也可能取决于用于诊断垂体功能减退症的内分泌测试和标准。
系统综述了报告 TBI 后成人（≥1 年）垂体功能减退症患病率的研究，重点是使用的（动态）测试和生化标准。
我们纳入了 14 项研究的数据，共 931 例患者。垂体功能减退症的定义差异很大。总体而言，严重 GH 缺乏症的报告患病率在 2%至 39%之间变化。使用 GHRH-精氨酸试验（<9μg/l 为界值）的患病率为 8-20%，使用胰高血糖素试验（<1-5μg/l 为界值）的患病率为 11-39%，使用 GHRH 试验（无界值）的患病率为 2%，使用胰岛素耐量试验（ITT；<3μg/l 为界值）的患病率为 15-18%。总体而言，继发性肾上腺功能不全的报告患病率范围很广，从 0 到 60%。基础皮质醇（<220 或<440nmol/l 为界值）的患病率为 0-60%，ACTH 试验的患病率为 7-19%，ITT 作为初次试验（<500 或<550nmol/l 为界值）的患病率为 5%。游离甲状腺素的 0-19%存在继发性甲状腺功能减退症，甲状腺释放激素刺激的 5-15%存在继发性甲状腺功能减退症。继发性性腺功能减退症的患病率为 0-29%。
TBI 后垂体功能减退症患病率的差异部分是由定义、垂体功能减退症的内分泌评估以及混杂因素的差异引起的。这些方法学问题使得在荟萃分析或综述的角度上对 TBI 相关垂体功能减退症的原始研究结果进行简单的概括变得困难。
