动脉瘤性蛛网膜下腔出血后腺垂体功能减退的研究进展

Progress in clinical diagnosis and treatment of hypopituitorism after aneurysmal subarachnoid hemorrhage

腺垂体功能减退在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者中并不少见。腺垂体功能减退在aSAH的急慢性期均可发生,且具有不同的临床特征。急性期垂体肾上腺皮质轴功能减退有重要的临床意义,严重的垂体肾上腺皮质功能减退会导致肾上腺危象。慢性期生长激素轴和垂体肾上腺皮质轴受累最常见,垂体性腺轴和垂体甲状腺轴也可受累,常表现为疲乏、运动能力下降、认知障碍、性欲减退等症状。aSAH后发生腺垂体功能减退的具体机制及危险因素目前尚不明确。aSAH急性期应关注垂体肾上腺皮质轴功能的监测,慢性期出现相关症状时,应进行腺垂体功能的全面评估。aSAH患者腺垂体功能减退的诊断主要依据激素基础水平的测定和激发试验。aSAH急性期出现的垂体肾上腺皮质轴功能减退对患者预后的影响较大,应给予糖皮质激素替代治疗。慢性期并发的腺垂体功能减退对aSAH患者的认知和生活质量会造成持久的影响,均应进行相应的激素替代治疗。

Hypopituitorism is not uncommon in patients with aneurysmal subarachnoid hemorrhage(aSAH).It can happen both in acute and chronic stages of aSAH.There are different clinical features of hypopituitorism happened in acute and chronic stages.In the acute stage,pituitary-adrenocortical axis dysfunction is of the most clinically significant,which can cause adrenal crisis.Growth hormone deficiency and pituitary-adrenocortical axis dysfunction are the two most common endocrine deficits in the chronic stage,symptoms include fatigue,decreased exercise capacity,cognitive impairment and decreased libido et al.The mechanism and risk factors of hypopituitorism are still unclear.The function of pituitary-adrenal axis should be paid attention for patients with aSAH during the acute phase.If patients manifest symptoms related to hypopituitorism during the chronic stage,comprehensive evaluation of pituitary function should be carried out.The diagnosis of hypopituitorism should be based on basic hormone level and corresponding stimulation test.Hypocortisolism in the acute phase of aSAH should be treated with glucocorticoid because of its potential contribution to the morbidity and mortality.Hypopituitorism occurred in the chronic phase of aSAH may have lasting effect on cognition and life quality,and hormone replacement should be carried out once the diagnosis be confirmed.