摘要：

重型颅脑创伤患者下丘脑垂体功能障碍发生率高达40%，但易被重型颅脑创伤相似临床表现所掩盖，导致漏诊或误诊，影响患者长期预后及生活质量，因此需纳入多模态神经重症监护。急性期（伤后72 h内）有15% ~ 20% 患者并发低钠血症，亦发生肾上腺皮质功能障碍，游离皮质醇测定更具诊断价值；慢性期（伤后3个月后）有18% ~ 37% 患者生长激素缺乏、下丘脑-垂体-性腺轴功能障碍，血清胰岛素样生长因子-1水平与认知功能相关但易误诊，平均诊断延误14个月。临床管理应实现三大转变，即从急性期保障患者生命安全向注重患者预后和功能转变，从激素替代治疗向神经修复转变，从单纯神经外科向神经外科、神经重症科、内分泌科、康复医学科等多学科整合转变，以提高患者生存率，改善生活质量。

关键词: 脑损伤, 创伤性, 下丘脑-垂体系统, 低钠血症, 肾上腺功能减退, 生长激素, 预后, 综述

Abstract:

The incidence of hypothalamic-pituitary dysfunction in patients with severe traumatic brain injury (sTBI) reaches up to 40%. However, it is often masked by clinical manifestations similar to those of sTBI, leading to underdiagnosis and misdiagnosis, which adversely affects long-term prognosis and quality of life. Therefore, integration into multimodal neurocritical care is essential. During the acute phase (within 72 h post-injury), 15%-20% of patients develop hyponatremia, and adrenal cortical dysfunction may also occur. In such cases, the determination of free cortisol holds greater diagnostic value. In the chronic phase (beyond 3 months post-injury), 18%-37% of patients exhibit growth hormone (GH) deficiency and hypothalamic-pituitary-gonadal (HPG) axis dysfunction. Although serum insulin-like growth factor-1 (IGF-1) levels are associated with cognitive function, they are prone to misdiagnosis, resulting in an average diagnostic delay of 14 months. Clinical management requires three major shifts: transitioning from ensuring patient survival in the acute phase to focusing on long-term prognosis and functional outcomes, moving from hormone replacement therapy toward neural repair, and evolving from a solely neurosurgical approach to a multidisciplinary integration involving neurocritical care, endocrinology and rehabilitation medicine. These transformations are crucial for improving survival rates and quality of life.

Key words: Brain injuries, traumatic, Hypothalamo-hypophyseal system, Hyponatremia, Adrenal insufficiency, Growth hormone, Prognosis, Review