Occurrence and influencing factors of pituitary dysfunction after severe craniocerebral trauma
LUO Fangjie1, QIN Zhizhen2, LI Xiaoyun1, DENG Jingyang1
1. Department of Neurosurgery,Songshanhu Central Hospital, Dongguan 523326, China; 2. Department of Neurooncology, the Third Medical Center of PLA General Hospital, Beijing 523326, China
Abstract：Objective To investigate the current status and influencing factors of pituitary dysfunction after severe craniocerebral trauma. Methods A total of 200 patients with severe craniocerebral trauma admitted to Songshanhu Central Hospital in Dongguan City were selected and divided into two groups according to whether the patients suffered from hypopituitarism (45 cases) and normal group (155 cases). The differences of clinical data between the two groups were investigated and compared, the related factors that might affect pituitary function were compared and Logistics regression analysis was conducted. Results The incidence of pituitary dysfunction in 200 severe patients was 22.50%, mainly thyroid function, adrenal function and gonadal function. The incidence of Glasgow Coma Scale (GCS) score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, cerebral herniation, diffuse cerebral edema, skull base fracture, ICU stay>10 days and hospitalization >28 days in the reduced group was higher than that in the normal group (P<0.05). According to logistic regression analysis, the risk factors for pituitary dysfunction included GCS score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, skull base fracture and diffuse cerebral edema. The inclusion of GCS score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, skull base fracture and diffuse cerebral edema in receiver operating characteristic (ROC) analysis had higher clinical value in predicting pituitary dysfunction by combining various risk factors. Conclusions The risk of pituitary dysfunction after severe craniocerebral trauma is closely related to factors such as intracranial pressure, skull base fractures, diffuse brain edema, GCS scores and other factors. Clinical attention and timely intervention should be paid to ensure the life safety of patients.
罗方接, 秦至臻, 李小云, 邓景阳. 重度颅脑创伤后垂体功能减退的发生现状及影响因素[J]. 武警医学, 2024, 35(12): 1053-1057.
LUO Fangjie, QIN Zhizhen, LI Xiaoyun, DENG Jingyang. Occurrence and influencing factors of pituitary dysfunction after severe craniocerebral trauma. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(12): 1053-1057.
Plavov O, Martinez-Perez R, Garcia-Ballestas E,et al. Re: A national survey of clinical practice of surveillance for post-traumatic brain injury hypopituitarism in the United Kingdom and Ireland[J]. Br J Neurosurg,2021,35(6):800.
[3]
Aungkawattanapong N, Jakchai K, Tempark T, et al. Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol[J]. J Pediatr Endocrinol Metab,2022,35(8):1078-1088.
[4]
江基尧.颅脑创伤临床救治指南[M].上海:第二军医大学出版社,2015:12-13.
[5]
Bodien Y G, Barra A, Temkin N R, et al. Diagnosing level of cnsciousness: the limits of the Glasgow coma scale total score[J]. J Neurotrauma,2021,38(23):3295-3305.
Mohd Salleh N, Theophilus S C, Rahman N A A, et al. Chronic anterior pituitary dysfunction following traumatic head injury: prospective study in hospital sultanah aminah johor bahru, malaysia[J]. Malays J Med Sci, 2023,30(1):107-115.
Gilis-Januszewska A, Kluczyński Ł, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms[J]. Endocr Connect,2020 ,9(5):112-123.
Emelifeonwu J A, Flower H, Loan J J, et al. Prevalence of anterior pituitary dysfunction twelve months or more following traumatic brain injury in adults: a systematic review and meta-analysis[J]. J Neurotrauma,2020,37(2):217-226.
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