Giavoli Claudia, Tagliabue Claudia, Profka Eriselda, Senatore Laura, Bergamaschi Silvia, Rodari Giulia, Spada Anna, Beck-Peccoz Paolo, Esposito Susanna
Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
BMC Endocr Disord. 2014 Oct 6;14:80. doi: 10.1186/1472-6823-14-80.
A number of studies of adults have shown that pituitary deficiencies can develop in a considerable proportion of subjects during the acute phase of meningitis or years after the infection has disappeared. The results of the very few studies of the impact of pediatric meningitis on hypothalamic-pituitary function are conflicting.
In order to determine the incidence of pituitary dysfunction in children with central nervous system infection, we evaluated pituitary function and anthropometric parameters in 19 children with meningitis of different etiologies (15 males; mean age ± standard deviation [SD] at pituitary evaluation, 5.9 ± 4.0 years; mean time from the acute event ± SD, 18 ± 10 months).
All of the subjects had a normal stature and growth velocity for their age and gender, and none of them was obese. On the basis of Tanner's reference charts, 17 subjects (13 boys and all four girls) were pre-pubertal; two boys were in Tanner stage 2. None of the subjects had central hypothyroidism. All of the patients had normal serum of insulin growth factor (IGF)-I and prolactin. Their sex steroid and gonadotropin levels were concordant with their age and pubertal status. Early morning urine osmolality and serum electrolyte levels showed no signs of diabetes insipidus. All of the patients had normal plasma adrenocorticotropic hormone (ACTH) levels. Peak cortisol responses to the standard dose Synacthen test (SDST) were normal in all cases.
The results showed that hypopituitarism following infectious meningitis appears to be infrequent in childhood and children's pituitary glands seem to be less vulnerable to damage than those of adults.
多项针对成年人的研究表明，相当一部分受试者在脑膜炎急性期或感染消失后的数年中会出现垂体功能减退。关于小儿脑膜炎对下丘脑 - 垂体功能影响的研究极少，结果相互矛盾。
为了确定中枢神经系统感染患儿垂体功能障碍的发生率，我们评估了19例不同病因脑膜炎患儿的垂体功能和人体测量参数（15例男性；垂体评估时的平均年龄±标准差[SD]，5.9±4.0岁；距急性事件的平均时间±SD，18±10个月）。
所有受试者的身高和生长速度与其年龄和性别相符，且均无肥胖。根据坦纳参考图表，17例受试者（13名男孩和所有4名女孩）处于青春期前；2名男孩处于坦纳2期。所有受试者均无中枢性甲状腺功能减退。所有患者的胰岛素生长因子（IGF）-I和催乳素血清水平均正常。他们的性类固醇和促性腺激素水平与其年龄和青春期状态相符。清晨尿渗透压和血清电解质水平未显示尿崩症迹象。所有患者的血浆促肾上腺皮质激素（ACTH）水平均正常。所有病例对标准剂量辛纳肽试验（SDST）的皮质醇峰值反应均正常。
结果表明，感染性脑膜炎后垂体功能减退在儿童中似乎并不常见，儿童的垂体腺似乎比成年人的垂体腺更不易受损。
