Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
J Pediatr. 2010 Dec;157(6):894-9. doi: 10.1016/j.jpeds.2010.07.004. Epub 2010 Aug 24.
To identify the incidence of endocrine dysfunction in children following traumatic brain injury (TBI).
This was a prospective evaluation of 31 children after TBI. Inclusion criteria included Glasgow Coma Scale score ≤ 12 and age 1.5-18 years. We evaluated thyroid function, insulin-like growth factor I, insulin-like growth factor-binding protein 3, and cortisol at 1, 3, 6, and 12 months after injury, and assessed prolactin at 3 and 6 months. At 6 months, we also assessed overnight spontaneous growth hormone secretion, nocturnal thyrotropin surge, adrenal reserve, and serum and urine osmolarity.
The average patient age was 11.6 years, and mean Glascow Coma Scale score was 6. The incidence of endocrine dysfunction was 15% at 1 month, 75% at 6 months, and 29% at 12 months. At 12 months after injury, 14% had precocious puberty, 9% had hypothyroidism, and 5% had growth hormone deficiency. Endocrine dysfunction at 1 year did not correlate with the severity of injury.
Endocrine dysfunction after TBI is common in children, but most cases resolve by 1 year. We recommend endocrine surveillance at both 6 and 12 months following moderate or severe TBI to ensure early intervention for persistent or late-occurring endocrine sequelae.
确定颅脑损伤（TBI）后儿童内分泌功能障碍的发生率。
这是对 31 例 TBI 后儿童的前瞻性评估。纳入标准包括格拉斯哥昏迷量表评分≤12 分和年龄 1.5-18 岁。我们在损伤后 1、3、6 和 12 个月评估甲状腺功能、胰岛素样生长因子 I、胰岛素样生长因子结合蛋白 3 和皮质醇，并在 3 和 6 个月评估催乳素。在 6 个月时，我们还评估了夜间自发性生长激素分泌、夜间促甲状腺激素激增、肾上腺储备以及血清和尿液渗透压。
患者平均年龄为 11.6 岁，格拉斯哥昏迷量表评分平均为 6。内分泌功能障碍的发生率为 1 个月时 15%，6 个月时 75%，12 个月时 29%。损伤后 12 个月时，14%有性早熟，9%有甲状腺功能减退，5%有生长激素缺乏症。1 年后的内分泌功能障碍与损伤的严重程度无关。
TBI 后儿童内分泌功能障碍很常见，但大多数病例在 1 年内可恢复。我们建议在中度或重度 TBI 后 6 个月和 12 个月进行内分泌监测，以确保对持续或迟发性内分泌后遗症进行早期干预。
