重型颅脑创伤患者早期并发腺垂体功能减退的临床诊治分析

Clinical diagnosis and treatment of hypopituitorism for patients with severe traumatic brain injury in acute phase

目的探讨重型颅脑创伤(traumatic brain injury,TBI)后早期并发腺垂体功能减退患者的临床特征、诊断和治疗方法。方法对吉林大学中日联谊医院神经外科2017年1月至2018年9月诊治的24例重型TBI后并发腺垂体功能减退的患者进行回顾性分析。结果TBI发生后3~7 d内进行腺垂体功能评估发现,并发腺垂体功能减退的重型TBI患者占同期收治的重型TBI患者的15.2%(24/158)。24例平均年龄35.8岁,范围为18~65岁,入院时平均GCS评分5.6分,范围为3~8分。垂体靶腺轴受累情况:垂体-肾上腺皮质轴功能减退9例,垂体-甲状腺轴功能减退7例,垂体-甲状腺轴和垂体-肾上腺皮质轴同时受累6例,生长激素轴功能减退1例,垂体-性腺轴功能减退1例。垂体-肾上腺皮质轴功能减退的患者给予氢化可的松替代治疗,垂体-甲状腺轴功能减退的患者给予左甲状腺素替代治疗。所有患者均于伤后3个月进行随访,垂体-甲状腺轴功能减退的患者中,61.5%(8/13)垂体甲状腺轴功能恢复正常。垂体-肾上腺皮质轴功能减退的患者中,40%(6/15)垂体肾上腺皮质轴功能恢复正常。生长激素轴和垂体性腺轴功能均恢复正常。结论重型TBI患者早期并发腺垂体功能减退并不少见,应引起足够重视。对重型TBI患者早期进行腺垂体功能的评估,筛查出严重的肾上腺皮质功能减退和甲状腺功能减退的患者,尽早进行激素替代治疗,对于改善患者预后有积极的意义。

Objective To explore the clinical features,diagnosis and treatment of hypopituitorism after severe traumatic brain injury(TBI)in acute phase.Methods Twenty-four patients with hypopituitorism after severe TBI that were diagnosed and treated in China-Japan Union Hospital from Jan.2017 to Sep.2018 were retrospectively analyzed.Results Pituitary function was evaluated between 3 to 7 days after TBI,and hypopituitorism was detected in 15.2%(24/158)of patients with severe TBI.The average age of the 24 patients was 35.8(range from 18 to 65)years,and the median GCS score on admission was 5.6(range from 3 to 8).The pituitary endocrine axis was involved as follows:hypofunction of pituitary-adrenal in 9 cases,hypofunction of pituitary-thyroid axis in 7 cases,hypofunction of pituitary-thyroid axis and pituitary-adrenal axis in 6 cases,hypofunction of growth hormone axis in 1 case and pituitary-gonad axis in 1 case.Hydrocortisone replacement was carried out in patients with hypofunction of pituitary-adrenocortical axis,and patients with hypofunction of pituitary-thyroid axis were given levothyroxine replacement therapy.All patients were followed up at 3 months after injury.Among the patients with pituitary-thyroid axis hypofunction,61.5%(8/13)returned to normal.The pituitary-adrenocortical axis function returned to normal in 40%(6/15)patients with pituitary-adrenocortical axis hypofunction.Both the function of the growth hormone axis and the pituitary-gonad axis returned to normal.Conclusions It is not uncommon for severe TBI patients to be complicated with hypopituitorism at early stage,which should be paid enough attention.Assessment of pituitary function at early stage can help to screen out the patients with severe adrenocortical hypofunction and hypothyroidism.Hormone replacement treatment should be carried out as early as possible,which has important significance for improving the prognosis of severe TBI patients.