Pituitary Function in the Acute Phase of Traumatic Brain Injury and Subarachnoid Hemorrhage

Background: Pituitary insufficiencies after traumatic brain injury (TBI) and subarachnoid haem-orrhage (SAH) have been reported with very varying frequencies. The aim of this study was to describe the pituitary function in the acute phase after TBI and SAH in a cohort of adults and relate the results to injury variables. Methods: Adults admitted to the neurointensive care unit in our hospital after moderate and severe TBI or SAH were included prospectively. Demographic, clinical, laboratory, including ACTH stimulation test, and radiological data were collected. Results: A total of 130 adults, 84 (19 women/65 men) with TBI and 46 (38 women/8 men) with SAH were included. Nine patients with TBI and six patients with SAH responded insufficiently to ACTH stimulation;14 patients with TBI and 9 patients with SAH had low fT4 and low-normal TSH levels. No relations were seen between hormonal levels and injury variables. Conclusions: Pituitary deficiencies occur after TBI and SAH, and a continuous endocrine evaluation of these patients is important. Our study could not define a marker for increased risk for pituitary deficiency. The long-term clinical outcome of the pathological hormone levels in the early phase after TBI and SAH is not known in detail and further studies to elucidate this are needed.

依贝沙坦和阿替洛尔可改善高血压伴左心室肥大患者的舒张功能

Objectives and design: An abnormal diastolic filling is common in hypertensive left ventricular(LV) hypertrophy, a condition that may lead to heart failure and death. The renin-angiotensin-aldosterone system has been implicated in the development of LV hypertrophy. This study examines the effects of 48 weeks of double-blind treatment with the AT1 receptor blocker irbesartan and the beta-blocker atenolol on diastolic function. Methods: Diastolic function was evaluated in 115 hypertensive patients with LV hypertrophy by Doppler echocardiography mitral in-flow velocities calculated from the peak of early(E) and peak of late(A) diastolic velocities(E/A ratio), the E-wave deceleration time, the isovolumic relaxation time, the pulmonary venous flow velocity, and by the atrioventricular valve plane displacement method. Results: By similar reductions in blood pressure both groups progressively reduced the LV mass index, with a greater reduction in the irbesartan group(P=0.024). Diastolic function was improved similarly by irbesartan and atenolol; for example, the E/A ratio by 12 and 14%(P=0.022 and P< 0.001), and the pulmonary venous flow velocity by 10 and 7%(P=0.036 and P=0.001), respectively. The isovolumic relaxation time was improved by irbesartan(P=0.040) only, and was related to changes in LV geometry(P< 0.001). For atenolol, improvement in diastolic function was associated only with the reduction in blood pressure(P=0.048). An improvement in diastolic function appeared greater in concentric LV hypertrophy than in eccentric LV hypertrophy. Conclusions: Treatment based on atenolol or irbesartan improves diastolic function in patients with hypertensive LV hypertrophy to the same degree, but through different mechanisms.