Department of Endocrinology and Diabetes, Evangelismos Hospital, Athens, Greece.
Pituitary. 2019 Jun;22(3):283-295. doi: 10.1007/s11102-019-00944-0.
It is estimated that approximately 69 million individuals worldwide will sustain a TBI each year, which accounts for substantial morbidity and mortality in both children and adults. TBI may lead to significant neuroendocrine changes, if the delicate pituitary is ruptured. In this review, we focus on the anterior pituitary hormonal changes in the acute post-TBI period and we present the evidence supporting the need for screening of anterior pituitary function in the early post-TBI time along with current suggestions regarding the endocrine assessment and management of these patients.
Original systematic articles with prospective and/or retrospective design studies of acute TBI were included, as were review articles and case series.
Although TBI may motivate an acute increase of stress hormones, it may also generate a wide spectrum of anterior pituitary hormonal deficiencies. The frequency of post-traumatic anterior hypopituitarism (PTHP) varies according to the severity, the type of trauma, the time elapsed since injury, the study population, and the methodology used to diagnose pituitary hormone deficiency. Early neuroendocrine abnormalities may be transient, but additional late ones may also appear during the course of rehabilitation.
Acute hypocortisolism should be diagnosed and managed promptly, as it can be life-threatening, but currently there is no evidence to support treatment of acute GH, thyroid hormones or gonadotropins deficiencies. However, a more comprehensive assessment of anterior pituitary function should be undertaken both in the early and in the post-acute phase, since ongoing hormone deficiencies may adversely affect the recovery and quality of life of these patients.
据估计，每年全球约有 6900 万人遭受创伤性脑损伤（TBI），这导致儿童和成人的发病率和死亡率都很高。如果脆弱的垂体破裂，TBI 可能导致显著的神经内分泌变化。在这篇综述中，我们重点关注急性创伤性脑损伤后即刻的前垂体激素变化，并提出了在创伤后早期筛查前垂体功能的证据，同时还提出了关于这些患者内分泌评估和管理的建议。
纳入了具有前瞻性和/或回顾性设计研究急性 TBI 的原始系统文章，以及综述文章和病例系列。
尽管 TBI 可能会引起应激激素的急性增加，但它也可能导致广泛的前垂体激素缺乏。创伤后前垂体功能减退症（PTHP）的频率根据严重程度、创伤类型、受伤后时间、研究人群和用于诊断垂体激素缺乏症的方法而有所不同。早期神经内分泌异常可能是短暂的，但在康复过程中也可能出现其他晚期异常。
急性皮质醇功能减退症应迅速诊断和治疗，因为它可能危及生命，但目前没有证据支持治疗急性 GH、甲状腺激素或促性腺激素缺乏症。然而，应该在早期和急性后阶段更全面地评估前垂体功能，因为持续的激素缺乏可能会对这些患者的恢复和生活质量产生不利影响。
