遷延性の低血圧を伴った頭部外傷後下垂体前葉機能不全の1例
遷延する低血圧を症状とした頭部外傷後下垂体機能不全の1例を報告する。患者は64歳の男性, 自宅にて転倒後, 意識障害を伴って救急搬入された。来院時深昏睡かつ呼吸微弱であり気管挿管後に脳CTを施行, 急性硬膜下血腫を診断した。開頭血腫除去術後CTにて下垂体近傍に広範な低吸収域を認め, 同時に昇圧剤不応性の遷延した低血圧を伴ったため外傷後下垂体機能不全による二次性副腎機能不全を疑った。下垂体ホルモン値は, 性ホルモンを除く全種ホルモン分泌異常を認めた。ステロイド投与後血圧は極めて安定化し, 以後低体温療法とホルモン補充療法を行い救命し得た。頭部外傷後の下垂体機能不全については近年, 全世界において...
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| Published in | 日本救急医学会雑誌 Vol. 18; no. 6; pp. 229 - 235 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本救急医学会
2007
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-924X 1883-3772 |
| DOI | 10.3893/jjaam.18.229 |
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| Abstract | 遷延する低血圧を症状とした頭部外傷後下垂体機能不全の1例を報告する。患者は64歳の男性, 自宅にて転倒後, 意識障害を伴って救急搬入された。来院時深昏睡かつ呼吸微弱であり気管挿管後に脳CTを施行, 急性硬膜下血腫を診断した。開頭血腫除去術後CTにて下垂体近傍に広範な低吸収域を認め, 同時に昇圧剤不応性の遷延した低血圧を伴ったため外傷後下垂体機能不全による二次性副腎機能不全を疑った。下垂体ホルモン値は, 性ホルモンを除く全種ホルモン分泌異常を認めた。ステロイド投与後血圧は極めて安定化し, 以後低体温療法とホルモン補充療法を行い救命し得た。頭部外傷後の下垂体機能不全については近年, 全世界において多くの報告がなされているが, 頭部外傷後下垂体機能不全の発生を検知するには, 正確な診断と長期の経過観察が必要とされる。頭部外傷の診療に携わる医療者にとって, 本疾患の概念を認識しておき, 早急に下垂体機能不全の診断を行い, 適切なホルモン補充療法を開始することが患者の予後や生活の質を高める上において非常に重要である。 |
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| AbstractList | 遷延する低血圧を症状とした頭部外傷後下垂体機能不全の1例を報告する。患者は64歳の男性, 自宅にて転倒後, 意識障害を伴って救急搬入された。来院時深昏睡かつ呼吸微弱であり気管挿管後に脳CTを施行, 急性硬膜下血腫を診断した。開頭血腫除去術後CTにて下垂体近傍に広範な低吸収域を認め, 同時に昇圧剤不応性の遷延した低血圧を伴ったため外傷後下垂体機能不全による二次性副腎機能不全を疑った。下垂体ホルモン値は, 性ホルモンを除く全種ホルモン分泌異常を認めた。ステロイド投与後血圧は極めて安定化し, 以後低体温療法とホルモン補充療法を行い救命し得た。頭部外傷後の下垂体機能不全については近年, 全世界において多くの報告がなされているが, 頭部外傷後下垂体機能不全の発生を検知するには, 正確な診断と長期の経過観察が必要とされる。頭部外傷の診療に携わる医療者にとって, 本疾患の概念を認識しておき, 早急に下垂体機能不全の診断を行い, 適切なホルモン補充療法を開始することが患者の予後や生活の質を高める上において非常に重要である。 |
| Author | 玉井, 勇人 山本, 保博 横田, 裕行 中江, 竜太 寺本, 明 荒木, 尚 佐藤, 秀貴 |
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| References | 2) Lieberman SA, Oberoi AL, Gilkison CR, et al: Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 2001; 86: 2752-6. 14) Aimaretti G, Ambrosio MR, Di Somma C, et al: Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J Clin Endocrinol Metab 2005; 90: 6085-92. 12) Urban RJ, Harris P, Masel B: Anterior hypopituitarism following traumatic brain injury. Brain Inj 2005; 19: 349-58. 13) Benvenga S, Campenni A, Ruggeri RM, et al: Clinical review 113: Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000; 85: 1353-61. 17) Urban RJ: Hypopituitarism after acute brain injury. Growth Horm IGF Res 2006; 16 Suppl A: S25-9. 15) De Marinis L, Mancini A, Valle D, et al: Hypothalamic derangement in traumatized patients: growth hormone (GH) and prolactin response to thyrotropin-releasing hormone and GH-releasing hormone. Clin Endocrinol (Oxf) 1999; 50: 741-7. 11) Aimaretti G, Ambrosio MR, Benvenga S, et al: Hypopituitarism and growth hormone deficiency (GHD) after traumatic brain injury (TBI). Growth Horm IGF Res 2004; 14 Suppl A: S114-7. 18) Feibel J, Kelly M, Lee L, et al: Loss of adrenocortical suppression after acute brain injury: role of increased intracranial pressure and brain stem function. J Clin Endocrinol Metab 1983; 57: 1245-50. 3) Kelly DF, Gonzalo IT, Cohan P, et al: Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg 2000; 93: 743-52. 6) Aimaretti G, Ambrosio MR, Di Somma C, et al: Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004; 61: 320-6. 4) Agha A, Rogers B, Sherlock M, et al: Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 2004; 89: 4929-36. 19) Barton RN, Stoner HB, Watson SM: Relationships among plasma cortisol, adrenocorticotrophin, and severity of injury in recently injured patients. J Trauma 1987; 27: 384-92. 16) Tanriverdi F, Senyurek H, Unluhizarci K, et al: High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma. J Clin Endocrinol Metab 2006; 91: 2105-11. 1) 横田裕行, 小林士郎, 矢島浩三 : 重症頭部外傷における下垂体前葉ホルモン. Neurological Surgery 1985; 13: 973-80. 20) Chesnokova V, Melmed S: Neuro-immuno-endocrine modulation of the hypothalamic-pituitary-adrenal (HPA) axis by gp 130 signaling molecules. Endocrinology 2002; 143: 1571-4. 5) Bondanelli M, De Marinis L, Ambrosio MR, et al: Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 2004; 21: 685-96. 8) Dimopoulou I, Kouyialis AT, Tzanella M, et al: High incidence of neuroendocrine dysfunction in long-term survivors of aneurysmal subarachnoid hemorrhage. Stroke 2004; 35: 2884-9. 7) Kreitschmann-Andermahr I, Hoff C, Saller B, et al: Prevalence of pituitary deficiency in patients after aneurismal subarachnoid hemorrhage. J Clin Endocrinol Metab 2004; 89: 4986-92. 9) Schneider M, Schneider HJ, Stalla GK: Anterior pituitary hormone abnormalities following traumatic brain injury. J Neurotrauma 2005; 22: 937-46. 10) Bondanelli M, Ambrosio MR, Zatelli MC, et al: Hypopituitarism after traumatic brain inury. Eur J Endocrinol 2005; 152: 679-91. |
| References_xml | – reference: 1) 横田裕行, 小林士郎, 矢島浩三 : 重症頭部外傷における下垂体前葉ホルモン. Neurological Surgery 1985; 13: 973-80. – reference: 13) Benvenga S, Campenni A, Ruggeri RM, et al: Clinical review 113: Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000; 85: 1353-61. – reference: 15) De Marinis L, Mancini A, Valle D, et al: Hypothalamic derangement in traumatized patients: growth hormone (GH) and prolactin response to thyrotropin-releasing hormone and GH-releasing hormone. Clin Endocrinol (Oxf) 1999; 50: 741-7. – reference: 12) Urban RJ, Harris P, Masel B: Anterior hypopituitarism following traumatic brain injury. Brain Inj 2005; 19: 349-58. – reference: 4) Agha A, Rogers B, Sherlock M, et al: Anterior pituitary dysfunction in survivors of traumatic brain injury. J Clin Endocrinol Metab 2004; 89: 4929-36. – reference: 20) Chesnokova V, Melmed S: Neuro-immuno-endocrine modulation of the hypothalamic-pituitary-adrenal (HPA) axis by gp 130 signaling molecules. Endocrinology 2002; 143: 1571-4. – reference: 7) Kreitschmann-Andermahr I, Hoff C, Saller B, et al: Prevalence of pituitary deficiency in patients after aneurismal subarachnoid hemorrhage. J Clin Endocrinol Metab 2004; 89: 4986-92. – reference: 5) Bondanelli M, De Marinis L, Ambrosio MR, et al: Occurrence of pituitary dysfunction following traumatic brain injury. J Neurotrauma 2004; 21: 685-96. – reference: 11) Aimaretti G, Ambrosio MR, Benvenga S, et al: Hypopituitarism and growth hormone deficiency (GHD) after traumatic brain injury (TBI). Growth Horm IGF Res 2004; 14 Suppl A: S114-7. – reference: 2) Lieberman SA, Oberoi AL, Gilkison CR, et al: Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 2001; 86: 2752-6. – reference: 10) Bondanelli M, Ambrosio MR, Zatelli MC, et al: Hypopituitarism after traumatic brain inury. Eur J Endocrinol 2005; 152: 679-91. – reference: 17) Urban RJ: Hypopituitarism after acute brain injury. Growth Horm IGF Res 2006; 16 Suppl A: S25-9. – reference: 14) Aimaretti G, Ambrosio MR, Di Somma C, et al: Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study. J Clin Endocrinol Metab 2005; 90: 6085-92. – reference: 16) Tanriverdi F, Senyurek H, Unluhizarci K, et al: High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma. J Clin Endocrinol Metab 2006; 91: 2105-11. – reference: 3) Kelly DF, Gonzalo IT, Cohan P, et al: Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg 2000; 93: 743-52. – reference: 9) Schneider M, Schneider HJ, Stalla GK: Anterior pituitary hormone abnormalities following traumatic brain injury. J Neurotrauma 2005; 22: 937-46. – reference: 18) Feibel J, Kelly M, Lee L, et al: Loss of adrenocortical suppression after acute brain injury: role of increased intracranial pressure and brain stem function. J Clin Endocrinol Metab 1983; 57: 1245-50. – reference: 19) Barton RN, Stoner HB, Watson SM: Relationships among plasma cortisol, adrenocorticotrophin, and severity of injury in recently injured patients. J Trauma 1987; 27: 384-92. – reference: 6) Aimaretti G, Ambrosio MR, Di Somma C, et al: Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004; 61: 320-6. – reference: 8) Dimopoulou I, Kouyialis AT, Tzanella M, et al: High incidence of neuroendocrine dysfunction in long-term survivors of aneurysmal subarachnoid hemorrhage. Stroke 2004; 35: 2884-9. |
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| Snippet | 遷延する低血圧を症状とした頭部外傷後下垂体機能不全の1例を報告する。患者は64歳の男性, 自宅にて転倒後, 意識障害を伴って救急搬入された。来院時深昏睡かつ呼吸微弱であり気管挿管後に脳CTを施行, 急性硬膜下血腫を診断した。開頭血腫除去術後CTにて下垂体近傍に広範な低吸収域を認め,... |
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| SubjectTerms | 下垂体ホルモン 副腎機能不全 重症頭部外傷 |
| Title | 遷延性の低血圧を伴った頭部外傷後下垂体前葉機能不全の1例 |
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