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Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study

  • Clinical Article
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Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India, 110029

    Asheesh Tandon, Ashish Suri, Manish Kumar Kasliwal, Ashok Kumar Mahapatra & Veer Singh Mehta

  2. Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India, 110029

    Ajay Garg

  3. Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India, 110029

    Chitra Sarkar

  4. Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India, 110029

    T. D. Dogra

  5. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India, 110029

    R. M. Pandey

  6. Neurosurgery, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Ashish Suri

Authors
  1. Asheesh Tandon
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  2. Ashish Suri
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  3. Manish Kumar Kasliwal
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  4. Ashok Kumar Mahapatra
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  5. Veer Singh Mehta
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  6. Ajay Garg
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  7. Chitra Sarkar
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  8. T. D. Dogra
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  9. R. M. Pandey
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Correspondence to Ashish Suri.

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Comment

This paper researches an area of increasing attention, namely pituitary dysfunction following severe brain trauma. This paper suggests its most valuable function is predictive, and certainly the cortisol and thyroid axis should be investigated early in TBI, although for the most part the hormones appear to increase, in those we rely on in the short term.

Michael Powell

London, United Kingdom

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Tandon, A., Suri, A., Kasliwal, M.K. et al. Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study. Acta Neurochir 151, 1411–1417 (2009). https://doi.org/10.1007/s00701-009-0444-9

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  • DOI: https://doi.org/10.1007/s00701-009-0444-9

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