Department of Endocrinology and Metabolism, Erciyes University Medical School, Kayseri, Turkey.
Yeditepe University Medical Faculty, Istanbul, Turkey.
Pituitary. 2019 Jun;22(3):322-331. doi: 10.1007/s11102-019-00937-z.
After traumatic brain injury was accepted as an important etiologic factor of pituitary dysfunction (PD), awareness of risk of developing PD following sports-related traumatic brain injury (SR-TBI) has also increased. However there are not many studies investigating PD following SR-TBIs yet. We aimed to summarize the data reported so far and to discuss screening algorithms and treatment strategies.
Recent data on pituitary dysfunction after SR-TBIs is reviewed on basis of diagnosis, clinical perspectives, therapy, screening and possible prevention strategies.
Pituitary dysfunction is reported to occur in a range of 15-46.6% following SR-TBIs depending on the study design. Growth hormone is the most commonly reported pituitary hormone deficiency in athletes. Pituitary hormone deficiencies may occur during acute phase after head trauma, may improve with time or new deficiencies may develop during follow-up. Central adrenal insufficiency is the only and most critical impairment that requires urgent detection and replacement during acute phase. Decision on replacement of growth hormone and gonadal deficiencies should be individualized. Moreover these two hormones are abused by many athletes and a therapeutic use exemption from the league's drug policy may be required.
Even mild and forgotten SR-TBIs may cause PD that may have distressing consequences in some cases if remain undiagnosed. More studies are needed to elucidate epidemiology and pathophysiology of PD after SR-TBIs. Also studies to establish screening algorithms for PD as well as strategies for prevention of SR-TBIs are urgently required.
创伤性脑损伤（TBI）被认为是垂体功能障碍（PD）的一个重要病因后，人们对运动相关创伤性脑损伤（SR-TBI）后发生 PD 的风险的认识也有所提高。然而，目前还没有很多研究调查 SR-TBI 后 PD 的情况。我们旨在总结迄今为止报告的数据，并讨论筛查算法和治疗策略。
根据诊断、临床观点、治疗、筛查和可能的预防策略，对 SR-TBI 后垂体功能障碍的最新数据进行综述。
根据研究设计的不同，SR-TBI 后垂体功能障碍的发生率报告在 15-46.6%之间。生长激素是运动员中最常报告的垂体激素缺乏症。垂体激素缺乏症可能在头部创伤后的急性期发生，随着时间的推移可能会改善，或者在随访期间可能会出现新的缺乏症。中枢性肾上腺功能不全是唯一且最关键的损伤，需要在急性期紧急检测和替代。生长激素和性腺缺乏症的替代决策应个体化。此外，这两种激素被许多运动员滥用，可能需要从联盟的药物政策中获得治疗性使用豁免。
即使是轻微的、被遗忘的 SR-TBI 也可能导致 PD，如果不进行诊断，在某些情况下可能会产生令人痛苦的后果。需要进一步研究阐明 SR-TBI 后 PD 的流行病学和发病机制。此外，还迫切需要研究建立 PD 的筛查算法以及预防 SR-TBI 的策略。
