Section of Child Life & Health, University of Edinburgh Royal Hospital for Sick Children, Edinburgh, UK.
Clin Endocrinol (Oxf). 2010 Nov;73(5):637-43. doi: 10.1111/j.1365-2265.2010.03857.x.
Post-traumatic hypopituitarism is well described amongst adult traumatic brain injury (TBI) survivors. We aimed to determine the prevalence and clinical significance of pituitary dysfunction after head injury in childhood.
Retrospective exploratory study.
33 survivors of accidental head injury (27 boys). Mean (range) age at study was 13·4 years (5·4-21·7 years) and median (range) interval since injury 4·3 years (1·4-7·8 years). Functional outcome at study: 15 good recovery, 16 moderate disability, two severe disability.
Early morning urine osmolality and basal hormone evaluation were followed by the gonadotrophin releasing hormone (GnRH) and insulin tolerance (n = 25) or glucagon tests (if previous seizures, n = 8). Subjects were not primed. Head injury details were extracted from patient records.
No subject had short stature (mean height SD score +0·50, range -1·57 to +3·00). Suboptimal GH responses (<5 μg/l) occurred in six peri-pubertal boys (one with slow growth on follow-up) and one postpubertal adolescent (peak GH 3·2 μg/l). Median peak cortisol responses to insulin tolerance or glucagon tests were 538 and 562 nm. Nine of twenty-five and two of eight subjects had suboptimal responses, respectively, two with high basal cortisol levels. None required routine glucocorticoid replacement. In three, steroid cover was recommended for moderate/severe illness or injury. One boy was prolactin deficient. Other basal endocrine results and GnRH-stimulated LH and FSH were appropriate for age, sex and pubertal stage. Abnormal endocrine findings were unrelated to the severity or other characteristics of TBI or functional outcome.
No clinically significant endocrinopathy was identified amongst survivors of accidental childhood TBI, although minor pituitary hormone abnormalities were observed.
创伤后垂体功能减退症在成人创伤性脑损伤（TBI）幸存者中已有详细描述。我们旨在确定儿童头部外伤后垂体功能障碍的患病率和临床意义。
回顾性探索性研究。
33 例意外头部损伤幸存者（27 名男孩）。研究时的平均（范围）年龄为 13.4 岁（5.4-21.7 岁），中位数（范围）伤后间隔时间为 4.3 年（1.4-7.8 年）。研究时的功能结局：15 例完全恢复，16 例中度残疾，2 例严重残疾。
进行清晨尿渗透压和基础激素评估，然后进行促性腺激素释放激素（GnRH）和胰岛素耐量（n = 25）或胰高血糖素试验（如果有既往癫痫发作，n = 8）。未进行预激。从患者记录中提取头部损伤细节。
无受试者身材矮小（平均身高标准差评分+0.50，范围-1.57 至+3.00）。6 名青春期前男孩（1 名随访时生长缓慢）和 1 名青春期后青少年（峰值 GH 3.2μg/l）的 GH 反应不佳（<5μg/l）。胰岛素耐量或胰高血糖素试验的中位皮质醇峰值反应分别为 538 和 562nm。25 名受试者中有 9 名和 8 名受试者中有分别有 2 名的反应不佳，其中 2 名的基础皮质醇水平较高。无常规需要糖皮质激素替代治疗。在 3 名患者中，建议在中度/重度疾病或损伤时使用类固醇覆盖。1 名男孩催乳素缺乏。其他基础内分泌结果和 GnRH 刺激的 LH 和 FSH 与年龄、性别和青春期阶段相符。内分泌异常与 TBI 的严重程度或其他特征或功能结局无关。
在意外儿童 TBI 幸存者中未发现临床显著的内分泌疾病，但观察到轻微的垂体激素异常。
