In Reply We thank Benvenga et al for their thoughtful commentary on our article¹ examining abnormal menstrual patterns in adolescents and young women after sport-related concussion. These authors discuss several key issues related to our article including references, mechanisms for our findings, and future research. The references^2,3 noted by the authors and not included in our article represent significant contributions to the literature detailing the association of severe traumatic brain injury (TBI) and hypopituitarism. However, we noted differences between the patients in these case series and those from our study. Specifically, approximately half of the patients^2,3 were male, most were either prepubertal or adult, and experienced severe, non–sport-related TBI. Yet the results from these studies are applicable to our study. By demonstrating pituitary dysfunction using hormonal assessment, Acerini et al² reported gonadotropin deficiencies in 80% (n = 16 of 20) of pediatric patients following severe TBI. All 3 of the female adolescents with severe TBI (skull fractures) in these series^2,3 exhibited gonadotropin deficiencies 2 to 5 years after injury, and at least one reported amenorrhea. These findings suggest that gonadotropin deficiencies may be a long-term consequence of TBI. Perhaps, as we stated in our article, “more subtle forms of brain injury, such as concussion, may adversely affect HPO [hypothalamic-pituitary-ovarian] axis function…leading to disrupted gonadotropin secretion.”¹

在答复中，我们感谢Benvenga等人对我们的文章¹进行了周到的评论，该文章检查了与运动有关的脑震荡后青少年的月经异常。这些作者讨论了与本文相关的几个关键问题，包括参考文献，我们的发现机制以及未来的研究。参考文献^{2 ，3}由作者指出，不包含在我们的文章表示文献显著贡献细节重型颅脑损伤（TBI）和垂体功能减退的关联。但是，我们注意到这些病例系列中的患者与本研究中的患者之间存在差异。具体地讲，大约一半的患者^{2 ，3}是男性，大多数是青春期前或成年，并且经历了严重的，非运动相关的TBI。这些研究的结果仍然适用于我们的研究。Acerini等[ ^2]通过荷尔蒙评估证实垂体功能障碍，报道严重TBI后80％（n = 20的16）儿科患者的促性腺激素缺乏症。在这些系列中的女性青少年有严重脑外伤（颅骨骨折）的全部3 ^{2 ，3}受伤后2至5年表现出促性腺激素缺乏症，并且至少有1例报告闭经。这些发现表明促性腺激素缺乏症可能是TBI的长期后果。如我们在文章中所述，也许“脑震荡等更细微的脑损伤形式可能会对HPO（下丘脑-垂体-卵巢）轴功能产生不利影响，从而导致促性腺激素分泌中断。” ^1个