Wilkinson Charles W, Pagulayan Kathleen F, Petrie Eric C, Mayer Cynthia L, Colasurdo Elizabeth A, Shofer Jane B, Hart Kim L, Hoff David, Tarabochia Matthew A, Peskind Elaine R
Geriatric Research, Education and Clinical Center, VA Puget Sound Health Care System Seattle, WA, USA.
Front Neurol. 2012 Feb 7;3:11. doi: 10.3389/fneur.2012.00011. eCollection 2012.
Studies of traumatic brain injury from all causes have found evidence of chronic hypopituitarism, defined by deficient production of one or more pituitary hormones at least 1 year after injury, in 25-50% of cases. Most studies found the occurrence of posttraumatic hypopituitarism (PTHP) to be unrelated to injury severity. Growth hormone deficiency (GHD) and hypogonadism were reported most frequently. Hypopituitarism, and in particular adult GHD, is associated with symptoms that resemble those of PTSD, including fatigue, anxiety, depression, irritability, insomnia, sexual dysfunction, cognitive deficiencies, and decreased quality of life. However, the prevalence of PTHP after blast-related mild TBI (mTBI), an extremely common injury in modern military operations, has not been characterized. We measured concentrations of 12 pituitary and target-organ hormones in two groups of male US Veterans of combat in Iraq or Afghanistan. One group consisted of participants with blast-related mTBI whose last blast exposure was at least 1 year prior to the study. The other consisted of Veterans with similar military deployment histories but without blast exposure. Eleven of 26, or 42% of participants with blast concussions were found to have abnormal hormone levels in one or more pituitary axes, a prevalence similar to that found in other forms of TBI. Five members of the mTBI group were found with markedly low age-adjusted insulin-like growth factor-I (IGF-I) levels indicative of probable GHD, and three had testosterone and gonadotropin concentrations consistent with hypogonadism. If symptoms characteristic of both PTHP and PTSD can be linked to pituitary dysfunction, they may be amenable to treatment with hormone replacement. Routine screening for chronic hypopituitarism after blast concussion shows promise for appropriately directing diagnostic and therapeutic decisions that otherwise may remain unconsidered and for markedly facilitating recovery and rehabilitation.
对各种原因导致的创伤性脑损伤的研究发现，在25%至50%的病例中存在慢性垂体功能减退的证据，其定义为受伤后至少1年一种或多种垂体激素分泌不足。大多数研究发现创伤后垂体功能减退（PTHP）的发生与损伤严重程度无关。生长激素缺乏（GHD）和性腺功能减退的报告最为频繁。垂体功能减退，尤其是成人GHD，与创伤后应激障碍（PTSD）的症状相似，包括疲劳、焦虑、抑郁、易怒、失眠、性功能障碍、认知缺陷和生活质量下降。然而，在现代军事行动中极为常见的爆炸相关轻度创伤性脑损伤（mTBI）后PTHP的患病率尚未明确。我们测量了两组参加过伊拉克或阿富汗战斗的美国男性退伍军人中12种垂体和靶器官激素的浓度。一组由爆炸相关mTBI的参与者组成，他们最后一次暴露于爆炸至少在研究前1年。另一组由具有相似军事部署历史但未暴露于爆炸的退伍军人组成。在26名有爆炸导致脑震荡的参与者中，有11名（42%）被发现一个或多个垂体轴的激素水平异常，这一患病率与其他形式的创伤性脑损伤相似。mTBI组中有5名成员的年龄校正胰岛素样生长因子-I（IGF-I）水平明显偏低，表明可能存在GHD，3名成员的睾酮和促性腺激素浓度与性腺功能减退一致。如果PTHP和PTSD的特征性症状都能与垂体功能障碍联系起来，那么它们可能适合用激素替代疗法治疗。对爆炸导致脑震荡后慢性垂体功能减退进行常规筛查，有望为合理指导诊断和治疗决策提供帮助，否则这些决策可能会被忽视，并显著促进康复和恢复。
