Title: Hormonal Dysfunction in Neurologic Injury
題目：神經系統外傷的荷爾蒙紊亂
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.
在危重的神經系統外傷（蛛網膜下腔出血，外傷性腦損傷）病人，初期治療的焦點是保持充足的腦灌注壓，控制顱內壓，和減少繼發性損失。
Once stabilized, however, it is important to consider endocrine dysfunction in the brain injured patient.
但是，一旦病情穩定，對于有腦損傷的病人就要考慮內分泌的紊亂。
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. 
內分泌紊亂在腦損傷中是常見的，并可增加合并癥和死亡率。事實上，超過一半以上的蛛網膜下腔出血的病人可出現急性下丘腦-垂體-腎上腺皮質軸系統紊亂，導致生長激素，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.
除了內分泌紊亂外，鈉離子異常（如低鈉血癥）可在80％以上的嚴重蛛網膜下腔出血的病人。
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.
可考慮在有明顯內分泌紊亂病人用激素替代療法（或在嚴重低鈉時應用高張鹽水），對有些病人來講，這種方法可能會挽救生命。

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