Keywords
deficiencia hipofisaria postraumática
lesión traumática cerebral
How to Cite
Abstract
Las LTC son una de las causas más comunes de hipopituitarismo en el adulto. La deficiencia hipofisaria postraumática se descubrió hace más de 90 años, pero sólo últimamente se le ha prestado la atención que merece. Los síntomas del hipopituitarismo mínimo son lentamente progresivos y no específicos, lo que dificulta su diagnóstico y retarda el tratamiento. Las causas más comunes de las LTC que producen deficiencia hipofisaria son los accidentes de tránsito y las caídas. El boxeo y el kickboxing, que característicamente producen traumas cerebrales repetidos, son causas del LTC, recientemente estudiados. El estallido de sustancias explosivas puede ser causa potencial de deficiencia hipofisaria anterior. La fisiopatología del hipopituitarismo postraumático cerebral no se conoce completamente. La predisposición genética, la autoinmunidad y la neuroinflamación se han propuesto como factores responsables del desarrollo de la deficiencia hipofisaria anterior. La formación de anticuerpos contra la pituitaria en alta concentración puede influir en el daño hipofisario a largo plazo. La neuroinflamación persistente producida por el trauma craneoencefálico puede influir en la formación del hipopituitarismo en pacientes predispuestos genéticamente (portadores de APOE3/E3). En adición, la autoinmunidad puede acrecentar los efectos nocivos de la neuroinflamación, lo que podría disminuir el volumen hipofisario y la disminución de la secreción de las tropinas. La deficiencia de HC es más frecuente en los portadores de las LTC y en los deportes combativos como el boxeo. El hipopituitarismo en personas con LTC puede acompañarse de hipófisis pequeñas demostradas por la resonancia magnética, lo que sugiere un mecanismo isquémico. Los pacientes con LTC y deficiencia hipofisaria anterior con frecuencia presentan trastornos metabólicos en particular demostrados en los niveles de glucosa, la resistencia a la insulina e hipertrigliceridemia, traducidos en una disminución en la calidad de vida.
La comprensión de posibles mecanismos neuroprotectores (capacidad de los vasos portales de regenerarse y la activación de las células progenitoras stem capaces de recuperar hipotéticamente las funciones adenohipofisiarias), es necesaria para tratar de prevenir el desarrollo o del hipopituitarismo permanente.
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