Title: Hormonal Dysfunction in Neurologic Injury
题目：神经系统外伤的荷尔蒙紊乱
Author 作者: Michael Winters

In the critically ill patient with neurologic injury (SAH, TBI), the initial treatment focus is to maintain adequate cerebral perfusion pressure, control intracranial pressure, and limit secondary injury.
在危重的神经系统外伤（蛛网膜下腔出血，外伤性脑损伤）病人，初期治疗的焦点是保持充足的脑灌注压，控制颅内压，和减少继发性损失。
Once stabilized, however, it is important to consider endocrine dysfunction in the brain injured patient.
但是，一旦病情稳定，对于有脑损伤的病人就要考虑内分泌的紊乱。
Endocrine dysfunction is common in neurologic injury and may lead to increased morbidity and mortality.  In fact, over half of SAH patients develop acute dysfunction of the HPA, resulting in low growth hormone, ACTH, and TSH. 
内分泌紊乱在脑损伤中是常见的，并可增加合并症和死亡率。事实上，超过一半以上的蛛网膜下腔出血的病人可出现急性下丘脑-垂体-肾上腺皮质轴系統紊乱，导致生长激素，ACTH，和TSH降低。
In addition to hormonal dysfunction, sodium abnormalities (i.e. hyponatremia) are present in up to 80% of critically ill SAH patients.
除了内分泌紊乱外，钠离子异常（如低钠血症）可在80％以上的严重蛛网膜下腔出血的病人。
Consider hormonal replacement therapy (or hypertonic saline in cases of severe hyponatremia) for patients with evidence of endocrine dysfunction.  For some, this therapy can be life-saving.
可考虑在有明显内分泌紊乱病人用激素替代疗法（或在严重低钠时应用高张盐水），对有些病人来讲，这种方法可能会挽救生命。

References 参考文献：
Vespa PM. Hormonal dysfunction in neurocritical patients. Curr Opin Crit Care 2013; 19:107-112.