Cob Alejandro
Endocrinología, Clínica Los Yoses, San José, Costa Rica.
J Med Case Rep. 2014 Sep 2;8:290. doi: 10.1186/1752-1947-8-290.
Anterior hypopituitarism is a common complication of head trauma, with a prevalence of 30% to 70% among long-term survivors. This is a much higher frequency than previously thought and suggests that most cases of post-traumatic hypopituitarism remain undiagnosed and untreated. Symptoms of hypopituitarism are very unspecific and very similar to those in traumatic brain injury patients in general, which makes hypopituitarism difficult to diagnose. The factors that predict the likelihood of developing hypopituitarism following traumatic brain injury remain poorly understood. The incidence of a specific hormone deficiency is variable, with growth hormone deficiency reported in 18% to 23% of cases.
A 23-year-old Hispanic man with a 2-year history of hypertension and diabetes presented with severe closed-head trauma producing diffuse axonal injury, subarachnoid hemorrhage and a brain concussion. A computed tomography scan showed a pituitary macroadenoma. The patient has clinical features of acromegaly and gigantism without other pituitary hyperfunctional manifestations or mass effect syndrome. A short-term post-traumatic laboratory test showed high levels of insulin like growth factor 1 and growth hormone, which are compatible with a growth hormone-producing pituitary tumor. At the third month post-trauma, the patient's levels of insulin like growth factor 1 had decreased to low normal levels, with basal low levels of growth hormone. A glucose tolerance test completely suppressed the growth hormone, which confirmed resolution of acromegaly. An insulin tolerance test showed lack of stimulation of growth hormone and cortisol, demonstrating hypopituitarism of both axes.
Even though hypopituitarism is a frequent complication of traumatic brain injury, there are no reports in the literature, to the best of my knowledge, of patients with hyperfunctional pituitary adenomas, such as growth hormone-producing adenoma, that resolved after head trauma. A clear protocol has not yet been established to identify which patients should be screened for hypopituitarism. Predictive factors that might determine the likelihood of developing post-traumatic hypopituitarism have not been clearly established, but there is no evidence of the presence of pituitary adenomas as a risk factor in otherwise healthy patients.
垂体前叶功能减退是头部外伤的常见并发症，在长期幸存者中的患病率为30%至70%。这一频率比先前认为的要高得多，表明大多数创伤后垂体功能减退病例仍未得到诊断和治疗。垂体功能减退的症状非常不具特异性，与一般创伤性脑损伤患者的症状非常相似，这使得垂体功能减退难以诊断。创伤性脑损伤后发生垂体功能减退可能性的预测因素仍知之甚少。特定激素缺乏的发生率各不相同，生长激素缺乏在18%至23%的病例中有所报道。
一名23岁患有高血压和糖尿病2年的西班牙裔男性，因严重闭合性头部外伤导致弥漫性轴索损伤、蛛网膜下腔出血和脑震荡。计算机断层扫描显示垂体大腺瘤。该患者具有肢端肥大症和巨人症的临床特征，无其他垂体功能亢进表现或占位效应综合征。创伤后短期实验室检查显示胰岛素样生长因子1和生长激素水平升高，这与产生生长激素的垂体肿瘤相符。创伤后第三个月，患者的胰岛素样生长因子1水平已降至低正常水平，基础生长激素水平较低。葡萄糖耐量试验完全抑制了生长激素，证实肢端肥大症已缓解。胰岛素耐量试验显示生长激素和皮质醇缺乏刺激，表明双轴垂体功能减退。
尽管垂体功能减退是创伤性脑损伤的常见并发症，但据我所知，文献中尚无头部外伤后功能性垂体腺瘤患者（如产生生长激素的腺瘤）病情缓解的报道。尚未建立明确的方案来确定哪些患者应接受垂体功能减退筛查。可能决定创伤后垂体功能减退发生可能性的预测因素尚未明确确立，但没有证据表明在其他方面健康的患者中垂体腺瘤的存在是一个危险因素。
