Clinical diagnosis and treatment of hypopituitorism for patients with severe traumatic brain injury in acute phase / 中华内分泌外科杂志

ABSTRACT

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.