Endocrine function in children acutely following severe traumatic brain injury.
Endocrine function in children acutely following severe traumatic brain injury.
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严重创伤性脑损伤后儿童急性内分泌功能。
DOI：
10.1007/s00381-009-1038-9
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
Adelson,PDavid
中科院分区：
文献类型：
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作者：
Srinivas,Ravi;Brown,SDanielle;Chang,Yue-Fang;Garcia-Fillion,Pamela;Adelson,PDavid
目的探讨成人和儿童颅脑损伤后额叶损伤的发生率，并可能合并下丘脑和垂体受累，但儿童颅脑损伤后急性内分泌功能障碍的研究尚未得到很好的研究。方法研究儿童重型颅脑损伤后的急性内分泌反应，包括皮质醇、促肾上腺皮质激素、促甲状腺激素、T3、T4、游离T4、GH和催乳素水平，包括皮质醇、促肾上腺皮质激素、促甲状腺激素、T3、T4、游离T4、生长激素和催乳素水平。方法采用格拉斯哥昏迷评分( ≤ 8)对重型颅脑损伤后儿童急性内分泌反应进行研究。37名1-17岁的儿童在伤后3天和7天(PID)分别获得治疗结果。6个月的随访采用格拉斯哥预后评分(GOS-E PEDS)来比较“好”(GOS-E PEDS 1-2)和“差”(GOS-E PEDS 3-5)的结果。皮质醇在PID1时显著升高(24.46 ± 13.41μg/dL)，但在PID3时恢复正常(10.14~19.92μg/dL)；46%和14%的儿童在急性期皮质醇和ACTH水平降低(分别为10.14和2)。结论综上所述，大多数儿童在重型颅脑损伤后急性期对创伤和应激的皮质醇反应发生了改变，尽管有相当比例的儿童似乎适当的皮质醇异常低。这些发现的意义还需要进一步研究，但这项研究初步揭示了严重脑外伤对儿童下丘脑-垂体轴急性反应的潜在影响。
PurposeDespite the prevalence of frontal injury following traumatic brain injury (TBI) in adults and children with potentially concomitant hypothalamic and pituitary involvement, endocrine dysfunction acutely following TBI has not been well studied in children.MethodsTo study the acute pediatric endocrine response after severe TBI (Glasgow Coma Scale ≤ 8), an endocrine panel, including cortisol, ACTH, TSH, T3, T4, free T4, GH, and prolactin levels, were obtained in 37 children (1–17 years) on the day of injury and post-injury days (PID) 3 and 7. Outcome was determined at 6-month follow-up using the Glasgow Outcome Score (GOS) extended modified for pediatric patients (GOS-E Peds) to compare “good” (GOS-E Peds 1–2) to “poor” (GOS-E Peds 3–5) outcomes.ResultsOur results showed that following severe TBI in children, cortisol was significantly elevated (24.46 ± 13.41 μg/dL) on PID 1 along with ACTH but then returned to normal (10.14–19.92 μg/dL) by PID 3; 46% and 14% of children had a low cortisol and ACTH (<10.14 and <2, respectively) in the acute period.ConclusionsIn summary, the cortisol response to trauma and stress in the acute period following severe TBI in the majority of children was altered, though seemingly appropriate cortisol was abnormally low in a significant percentage of children. Further study as to the significance of these findings is needed, but this study provides preliminary insight into the potential impact of severe TBI on the acute response of the hypothalamic–pituitary axis in children.