Silva Paula P B, Bhatnagar Saurabha, Herman Seth D, Zafonte Ross, Klibanski Anne, Miller Karen K, Tritos Nicholas A
1 Neuroendocrine Unit, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
2 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Harvard Medical School , Boston, Massachusetts.
J Neurotrauma. 2015 Nov 15;32(22):1789-95. doi: 10.1089/neu.2015.3998. Epub 2015 Sep 29.
Hypopituitarism may often occur in association with traumatic brain injury (TBI). Identification of reliable predictors of pituitary dysfunction is of importance in order to establish a rational testing approach. We searched the records of patients with TBI, who underwent neuroendocrine evaluation in our institution between 2007 and 2013. One hundred sixty-six adults (70% men) with TBI (median age: 41.6 years; range: 18-76) were evaluated at a median interval of 40.4 months (0.2-430.4).Of these, 31% had ≥1 pituitary deficiency, including 29% of patients with mild TBI and 35% with moderate/severe TBI. Growth hormone deficiency was the most common deficiency (21%); when body mass index (BMI)-dependent cutpoints were used, this was reduced to 15%. Central hypoadrenalism occurred in10%, who were more likely to have suffered a motor vehicle accident (MVA, p = 0.04), experienced post-traumatic seizures (p = 0.04), demonstrated any intracranial hemorrhage (p = 0.05), petechial brain hemorrhages (p = 0.017), or focal cortical parenchymal contusions (p = 0.02). Central hypothyroidism occurred in 8% and central hypogonadism in 12%; the latter subgroup had higher BMI (p = 0.03), were less likely to be working after TBI (p = 0.002), and had lower Global Assessment of Functioning (GAF) scores (p = 0.03). Central diabetes insipidus (DI) occurred in 6%, who were more likely to have experienced MVA (p < 0.001) or sustained moderate/severe TBI (p < 0.001). Patients with MVA and those with post-traumatic seizures, intracranial hemorrhage, petechial brain hemorrhages, and/or focal cortical contusions are at particular risk for serious pituitary dysfunction, including adrenal insufficiency and DI, and should be referred for neuroendocrine testing. However, a substantial proportion of patients without these risk factors also developed hypopituitarism.
垂体功能减退症常与创伤性脑损伤（TBI）相关。确定垂体功能障碍的可靠预测因素对于建立合理的检测方法至关重要。我们检索了2007年至2013年间在我们机构接受神经内分泌评估的TBI患者的记录。166名成年TBI患者（70%为男性）（中位年龄：41.6岁；范围：18 - 76岁）接受了评估，中位间隔时间为40.4个月（0.2 - 430.4个月）。其中，31%有≥1种垂体功能减退，包括29%的轻度TBI患者和35%的中度/重度TBI患者。生长激素缺乏是最常见的缺乏症（21%）；当使用依赖体重指数（BMI）的切点时，这一比例降至15%。中枢性肾上腺功能减退症发生率为10%，这些患者更有可能发生机动车事故（MVA，p = 0.04）、经历创伤后癫痫发作（p = 0.04）、出现任何颅内出血（p = 0.05）、点状脑内出血（p = 0.017）或局灶性皮质实质挫伤（p = 0.02）。中枢性甲状腺功能减退症发生率为8%，中枢性性腺功能减退症发生率为12%；后一亚组患者BMI较高（p = 0.03），TBI后工作的可能性较小（p = 0.002），且功能总体评估（GAF）得分较低（p = 0.03）。中枢性尿崩症（DI）发生率为6%，这些患者更有可能发生MVA（p < 0.001）或遭受中度/重度TBI（p < 0.001）。发生MVA的患者以及经历创伤后癫痫发作、颅内出血、点状脑内出血和/或局灶性皮质挫伤的患者尤其有发生严重垂体功能障碍的风险，包括肾上腺功能不全和DI，应转诊进行神经内分泌检测。然而，相当一部分没有这些危险因素的患者也发生了垂体功能减退症。
