Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study.
OBJECTIVE
The frequency and pattern of endocrine abnormalities among patients with traumatic brain injury have been the subject matter of very few studies. This study was intended to assess the pattern of endocrine dysfunction following severe head injury.


METHODS
Severe head injury patients admitted to the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, from January to December in 1 year formed the study group. Apart from clinical assessment, NCCT of the head was performed on all patients on admission. A complete anterior pituitary hormone analysis was performed within 24 h of injury and was repeated at 2 weeks, 3 months and 6 months amongst patients who survived.


RESULTS
A total of 99 patients were included in the study. Forty of our patients succumbed in the hospital. Rest of the patients were followed up for 6 months. Elevations of cortisol followed by prolactin were the most common hormonal derangements at admission. Midline shift on CT scans was inversely related to cortisol elevation and directly related to GH elevation. Infarct on CT scans was inversely related to cortisol and LH elevation. A significant alteration was found in the decreasing trend of the mean T4 values and normalisation or a decreasing trend from initially elevated mean cortisol and GH levels during follow-up (p < 0.05).


CONCLUSIONS
This study reveals that abnormalities in hormonal profiles appear to be relatively common in severe traumatic brain injury and fluctuate significantly over at least 6 months; there is a correlation with age and radiological findings. Performance of hormonal analysis evaluation should be considered in patients with severe brain injury so that appropriate hormonal replacement can be done to optimise the clinical outcome.
Tandon
Asheesh
A
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Suri
Ashish
A
Kasliwal
Manish Kumar
MK
Mahapatra
Ashok Kumar
AK
Mehta
Veer Singh
VS
Garg
Ajay
A
Sarkar
Chitra
C
Dogra
T D
TD
Pandey
R M
RM
D000328:Adult; D001929:Brain Edema / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004700:Endocrine System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood / Q000378:metabolism; D015994:Incidence; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D010902:Pituitary Gland / Q000293:injuries* / Q000378:metabolism / Q000503:physiopathology; D010907:Pituitary Hormones / Q000032:analysis / Q000097:blood / Q000378:metabolism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D010907:Pituitary Hormones; D006854:Hydrocortisone