title: Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality.
abstract: BACKGROUND
  Published data demonstrates that hypopituitarism is common after traumatic brain injury (TBI). Hormone deficiencies are transient in many, but the natural history of the acute changes after TBI has not been documented. In addition, it is not clear whether there are any early parameters that accurately predict the development of permanent hypopituitarism.
  
  
  OBJECTIVE
  There were 3 main objectives of this study: 1) to describe the natural history of plasma cortisol (PC) changes and sodium balance after TBI; 2) to identify whether acute hypocortisolemia or cranial diabetes insipidus (CDI) predict mortality; and 3) to identify whether the acute pituitary dysfunction predicts the development of chronic anterior hypopituitarism.
  
  
  METHODS
  Each TBI patient underwent sequential measurement of PC, plasma sodium, urine osmolality, and fluid balance after TBI. All other anterior pituitary hormones were measured on day 10 after TBI. The results from 15 surgical comparisons defined a PC less than 300 nmol/L as inappropriately low for an acutely ill patient. CDI was diagnosed according to standard criteria. Surviving TBI patients underwent dynamic anterior pituitary testing at least 6 months after TBI.
  
  
  METHODS
  The patients were recruited from the Irish National Neurosurgery Centre.
  
  
  METHODS
  One hundred sequential TBI patients were recruited. Fifteen patients admitted to Intensive Therapy Unit (ITU) after major surgery were recruited as comparison patients.
  
  
  METHODS
  PC in TBI patients was compared with that of comparison patients. The mortality rate was compared between TBI patients with and without acute hypocortisolemia. Results of follow-up dynamic pituitary testing were compared between those with and without acute hypocortisolemia.
  
  
  RESULTS
  Most of the TBI patients (78%) developed inappropriately low PC after TBI. Low PC and CDI were predictive of mortality. Thirty-nine percent of the patients who had follow-up testing had at least 1 pituitary hormone deficit, all of whom had had previous acute hypocortisolemia or CDI.
  
  
  CONCLUSIONS
  Acute hypocortisolemia and CDI are predictive of mortality and long-term pituitary deficits in TBI.
authors.affiliation: Academic Department of Endocrinology, Beaumont Hospital/Royal College of Surgeons in Ireland Medical School, Beaumont Hospital, Dublin 9, Ireland. markjhannon2002@yahoo.co.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Hannon
authors.forename: R K
authors.initials: RK
authors.lastname: Crowley
authors.forename: L A
authors.initials: LA
authors.lastname: Behan
authors.forename: E P
authors.initials: EP
authors.lastname: O'Sullivan
authors.forename: M M C
authors.initials: MM
authors.lastname: O'Brien
authors.forename: M
authors.initials: M
authors.lastname: Sherlock
authors.forename: D
authors.initials: D
authors.lastname: Rawluk
authors.forename: R
authors.initials: R
authors.lastname: O'Dwyer
authors.forename: W
authors.initials: W
authors.lastname: Tormey
authors.forename: C J
authors.initials: CJ
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000172:deficiency; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D020790:Diabetes Insipidus, Neurogenic / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000172:deficiency*; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010903:Pituitary Gland, Anterior / Q000503:physiopathology
chemical_list: D005938:Glucocorticoids; D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone