ABORDAJE TERAPÉUTICO EN FASE AGUDA DE LA LESIÓN HIPOFISARIA EN TRAUMA CRANEOENCEFÁLICO EN NIVELES DE MEDIANA Y ALTA COMPLEJIDAD EN SALUD. REVISIÓN DE LA LITERATURA
DOI:
https://doi.org/10.51437/nj.v29i2.399Keywords:
Trauma craneoencefálico, TCE, hipopituitarismo post traumático, PTHP, insuficiencia adrenal aguda, síndrome de secreción inadecuada de la hormona antidiurética, SIADH, Diabetes insípida.Abstract
Resumen:
Introducción: el trauma craneoencefálico (TCE) es considerado una epidemia mundial ya que afecta a más de 60 millones de personas cada año, dejando múltiples secuelas como hipopituitarismo post traumático (PTHP), una de las entidades más comunes pero menos estudiada en la urgencia. En fase aguda los pacientes pueden cursar con síntomas poco específicos y transitorios pero potencialmente mortales, como es el caso de la insuficiencia adrenal aguda, el síndrome de secreción inadecuada de ADH o la diabetes insípida. Es por esto que el artículo propone un algoritmo terapéutico para su manejo en fase aguda en hospitales de mediana y alta complejidad para así dar tratamiento oportuno y reducir las secuelas del TCE en estos pacientes.
Metodología: se utilizaron términos en inglés y español como: “trauma craneoencefálico + hipopituitarismo”, “hipopituitarismo postraumático”, “fisiopatología del PTHP”, “manejo del hipopituitarismo postraumático” en buscadores como PubMed, Sciencedirect, Google Scholar y Uptodate sin límite de tiempo que hablaran sobre población adulta con PTHP.
Resultados: se obtuvieron aproximadamente 180 artículos de los cuales se tomaron 63 para la revisión.
Conclusiones: el PTHP es una entidad frecuente en pacientes con TCE moderado o severo que debe sospecharse en fase aguda. El algoritmo planteado puede usarse en niveles de mediana y alta complejidad en salud para atender el PTHP en esta fase, sin embargo, es importante revalorar al paciente de seis a 12 meses posterior al trauma para hacer un diagnóstico definitivo y disminuir las posibles secuelas del TCE a largo plazo.
Palabras clave:
Trauma craneoencefálico, TCE, hipopituitarismo post traumático, PTHP, insuficiencia adrenal aguda, síndrome de secreción inadecuada de la hormona antidiurética, SIADH, Diabetes insípida.
Abstract
Introduction: traumatic brain injury (TBI) is considered a worldwide epidemic since it affects more than 60 million people every year, leaving multiple sequelae such as post-traumatic hypopituitarism (PTHP), one of the most common but less studied entities in the emergency department. In the acute phase, patients may present with non-specific and transient but potentially fatal symptoms, such as acute adrenal insufficiency, syndrome of inadequate ADH secretion or diabetes insipidus. This is why the article proposes a therapeutic algorithm for its management in the acute phase in medium and high complexity hospitals in order to provide timely treatment and reduce the sequelae of TBI in these patients.
Methodology: English and Spanish terms such as "traumatic brain injury + hypopituitarism", "post traumatic hypopituitarism", "physiopathology of PTHP", "management of posttraumatic hypopituitarism" were used in search engines such as PubMed, Sciencedirect, Google Scholar and Uptodate with no time limit, and include the adult population with PTHP.
Results: approximately 180 articles were obtained, of which 63 were taken for the review.
Conclusions: PTHP is a frequent entity in patients with moderate or severe TBI that should be suspected in the acute phase. The proposed algorithm can be used in medium and high complexity levels of health care to treat PTHP in this phase; however, it is important to reevaluate the patient six to 12 months after the trauma to make a definitive diagnosis and reduce the possible long-term sequelae of TBI.
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