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脑外伤可致不同程度的垂体前叶功能减退,可以是单一激素缺乏,亦可多个功能轴同时受累;可发生在急性期,亦可发生于康复期。虽诸多文献报告其发生率存在差异,但无论是急性期还是恢复期,其发生都相当普遍,严重影响脑外伤患者的康复进程。中重度外伤性脑损伤的垂体前叶功能减退的发生率更高,而轻者伴有垂体前叶功能减退的症状时也应进行垂体前叶功能的评估,且肾上腺皮质功能的检测必不可少。外伤性脑损伤急性期内基础血浆皮质醇<200nmol/L提示皮质功能减退,应予适当的糖皮质激素替代治疗;若基础血浆皮质醇大于200nmol/L而低于400nmol/L且合并低血压、低血钠和低血糖时,考虑临床诊断皮质功能减退并予适当糖皮质激素替代治疗,急性期后则根据情况决定是否继续应用。
Traumatic brain injury can cause varying degrees of anterior pituitary hypofunction can be a single hormone deficiency, but also multiple axis involvement; can occur in the acute phase can also occur in the rehabilitation period. Although there are many reports of differences in the incidence of these diseases, their occurrence has been quite common in both acute and convalescent cases, seriously affecting the rehabilitation process of patients with traumatic brain injury. The incidence of anterior pituitary hypofunction in patients with moderate or severe traumatic brain injury is higher, while in patients with mild hypothyroidism, the anterior pituitary function should be assessed, and the detection of adrenocortical function is essential . In the acute period of traumatic brain injury, the basic plasma cortisol <200nmol / L suggests that cortical dysfunction should be treated with appropriate glucocorticoid replacement therapy. If the basal plasma cortisol is more than 200nmol / L and less than 400nmol / L and with hypotension, Hyponatremia and hypoglycemia, consider the clinical diagnosis of cortical hypofunction and appropriate replacement therapy with glucocorticoid, after the acute phase is based on the situation decide whether to continue to use.