Czirják Sándor, Rácz Károly, Góth Miklós
Országos Idegtudományi Intézet Budapest.
Orv Hetil. 2012 Jun 17;153(24):927-33. doi: 10.1556/OH.2012.29399.
Posttraumatic hypopituitarism is of major public health importance because it is more prevalent than previously thought. The prevalence of hypopituitarism in children with traumatic brain injury is unknown. Most cases of posttraumatic hypopituitarism remain undiagnosed and untreated in the clinical practice, and it may contribute to the severe morbidity seen in patients with traumatic brain injury. In the acute phase of brain injury, the diagnosis of adrenal insufficiency should not be missed. Determination of morning serum cortisol concentration is mandatory, because adrenal insufficiency can be life threatening. Morning serum cortisol lower than 200 nmol/L strongly suggests adrenal insufficiency. A complete hormonal investigation should be performed after one year of the trauma. Isolated growth hormone deficiency is the most common deficiency after traumatic brain injury. Sports-related chronic repetitive head trauma (because of boxing, kickboxing, football and ice hockey) may also result in hypopituitarism. Close co-operation between neurosurgeons, endocrinologists, rehabilitation physicians and representatives of other disciplines is important to provide better care for these patients.
创伤后垂体功能减退具有重大的公共卫生意义，因为其患病率比之前认为的更高。创伤性脑损伤患儿垂体功能减退的患病率尚不清楚。在临床实践中，大多数创伤后垂体功能减退病例仍未得到诊断和治疗，这可能导致创伤性脑损伤患者出现严重的发病率。在脑损伤的急性期，不应漏诊肾上腺功能不全。必须测定早晨血清皮质醇浓度，因为肾上腺功能不全可能危及生命。早晨血清皮质醇低于200 nmol/L强烈提示肾上腺功能不全。创伤一年后应进行全面的激素检查。孤立性生长激素缺乏是创伤性脑损伤后最常见的缺乏症。与运动相关的慢性重复性头部创伤（如拳击、踢拳、足球和冰球）也可能导致垂体功能减退。神经外科医生、内分泌学家、康复医生和其他学科代表之间的密切合作对于为这些患者提供更好的护理非常重要。
