Download PDF
CC BY 4.0 · Indian Journal of Neurotrauma
DOI: 10.1055/s-0043-1769802
Original Article

Dilemmas in the Management of Acute TBI: A Prospective Observational Study of Anterior Pituitary Dysfunction and Its Correlation with Outcome

Ajay Choudhary
1   Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India
,
Shivender Sobti
2   Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
,
Nirankar Dev
3   Department of Neurosurgery, Asian Vivekananda Hospital, Moradabad, Uttar Pradesh, India
,
Bindu Kulshreshtha
4   Department of Endocrinology, ABVIMS and Dr. RML Hospital, New Delhi, India
,
Rajesh Sharma
1   Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India
,
Kaviraj Kaushik
1   Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India
,
Ashok Kumar
1   Department of Neurosurgery, ABVIMS and Dr. RML Hospital, New Delhi, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background The frequency and pattern of endocrinal abnormalities among patients with traumatic brain injury occur more frequently than previously suspected.

Objective The aim of this study was to assess anterior pituitary dysfunction in patients with moderate-to-severe traumatic brain injury and outcome after treatment.

Material and Methods One hundred patients with moderate-to-severe head injury presenting within 48 hours of injury were enrolled. Blood samples of all patients were taken for the hormonal assay at second day, at 2 weeks, 1 month, 3 months, and 6 months. Patients were evaluated by Glasgow coma scale (GCS), Glasgow outcome score (GOS), and hormone profile.

Results The median GCS score was 10/15. Forty-four patients were operated and 56 patients were managed medically. Seven operated patients expired; 30 patients had good recovery. In conservative group, 46 patients had good outcome and two patients died. Cortisol and thyroid hormone values were changed prominently, followed by prolactin and growth hormone. On univariate analysis, association of GOS with fT3, fT4, serum prolactin, and serum cortisol was seen. On multivariate analysis, strong correlation of GOS with f T4 values was seen (p = 0.008)

Conclusion Most of the hormonal deficiency occurs in immediate phase. Hormonal screening should be done to improve long term outcome.

Keywords

traumatic brain injury - anterior pituitary dysfunction - Glasgow coma scale - Glasgow outcome score - hormone


Publication History

Article published online:
13 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Behan LA, Phillips J, Thompson CJ, Agha A. Neuroendocrine disorders after traumatic brain injury. J Neurol Neurosurg Psychiatry 2008; 79 (07) 753-759
    CrossrefPubMedGoogle Scholar
  • 2 Molaie AM, Maguire J. Neuroendocrine abnormalities following traumatic brain injury: an important contributor to neuropsychiatric sequelae. Front Endocrinol (Lausanne) 2018; 9: 176
    CrossrefPubMedGoogle Scholar
  • 3 Yang W-H, Chen PC, Wang TC, Kuo TY, Cheng CY, Yang YH. Endocrine dysfunction following traumatic brain injury: a 5-year follow-up nationwide-based study. Sci Rep 2016; 6: 32987
    CrossrefPubMedGoogle Scholar
  • 4 Cyran E. HypophysenschädigungdurchSchädelbasisfraktur. Dtsch Med Wochenschr 1918; 44: 1261
    PubMedGoogle Scholar
  • 5 Kelly DF, Gonzalo IT, Cohan P, Berman N, Swerdloff R, Wang C. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report. J Neurosurg 2000; 93 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 6 Lieberman SA, Oberoi AL, Gilkison CR, Masel BE, Urban RJ. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab 2001; 86 (06) 2752-2756
    PubMedGoogle Scholar
  • 7 Leal-Cerro A, Flores JM, Rincon M. et al. Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury. Clin Endocrinol (Oxf) 2005; 62 (05) 525-532
    CrossrefPubMedGoogle Scholar
  • 8 Aimaretti G, Ambrosio MR, Di Somma C. et al. Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury. Clin Endocrinol (Oxf) 2004; 61 (03) 320-326
    CrossrefPubMedGoogle Scholar
  • 9 Springer J, Chollet A. A traumatic car crash. Lancet 2001; 357 (9271): 1848
    CrossrefPubMedGoogle Scholar
  • 10 Chioléro R, Berger M. Endocrine response to brain injury. New Horiz 1994; 2 (04) 432-442
    PubMedGoogle Scholar
  • 11 Şimşek T, Şimşek HU, Cantürk NZ. Response to trauma and metabolic changes: posttraumatic metabolism. Ulus Cerrahi Derg 2014; 30 (03) 153-159
    PubMedGoogle Scholar
  • 12 Bistritzer T, Theodor R, Inbar D, Cohen BE, Sack J. Anterior hypopituitarism due to fracture of the sella turcica. Am J Dis Child 1981; 135 (10) 966-968
    PubMedGoogle Scholar
  • 13 Maiya B, Newcombe V, Nortje J. et al. Magnetic resonance imaging changes in the pituitary gland following acute traumatic brain injury. Intensive Care Med 2008; 34 (03) 468-475
    CrossrefPubMedGoogle Scholar
  • 14 Gorczyca W, Hardy J. Arterial supply of the human anterior pituitary gland. Neurosurgery 1987; 20 (03) 369-378
    CrossrefPubMedGoogle Scholar
  • 15 Nussey S, Whitehead S. . The pituitary gland. Endocrinology: An Integrated Approach. BIOS Scientific Publishers Limited (2001). Accessed May 6, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK27/
    PubMed
  • 16 Tandon A, Suri A, Kasliwal MK. et al. Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study. Acta Neurochir (Wien) 2009; 151 (11) 1411-1417
    CrossrefPubMedGoogle Scholar
  • 17 Soules MR, Sheldon GW. Traumatic hypopituitarism: anterior hypophyseal insufficiency from indirect cranial trauma. South Med J 1979; 72 (12) 1592-1596
    CrossrefPubMedGoogle Scholar
  • 18 Prasanna KL, Mittal RS, Gandhi A. Neuroendocrine dysfunction in acute phase of moderate-to-severe traumatic brain injury: a prospective study. Brain Inj 2015; 29 (03) 336-342
    CrossrefPubMedGoogle Scholar
  • 19 Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85 (01) 109-117
    CrossrefPubMedGoogle Scholar
  • 20 Vanhorebeek I, Langouche L, Van den Berghe G. Endocrine aspects of acute and prolonged critical illness. Nat Clin Pract Endocrinol Metab 2006; 2 (01) 20-31
    CrossrefPubMedGoogle Scholar
  • 21 King LR, McLaurin RL, Lewis HP, Knowles Jr HC. Plasma cortisol levels after head injury. Ann Surg 1970; 172 (06) 975-984
    CrossrefPubMedGoogle Scholar
  • 22 Stieg MR, Renner U, Stalla GK, Kopczak A. Advances in understanding hypopituitarism. F1000 Res 2017; 6: 178
    CrossrefPubMedGoogle Scholar
  • 23 Melmed S. . The Pituitary. 4th ed. London, UK: Academic Press Is an Imprint of Elsevier; 2017
  • 24 Bondanelli M, Ambrosio MR, Margutti A. et al. Evidence for integrity of the growth hormone/insulin-like growth factor-1 axis in patients with severe head trauma during rehabilitation. Metabolism 2002; 51 (10) 1363-1369
    CrossrefPubMedGoogle Scholar
  • 25 Bushnik T, Englander J, Katznelson L. Fatigue after TBI: association with neuroendocrine abnormalities. Brain Inj 2007; 21 (06) 559-566
    CrossrefPubMedGoogle Scholar
  • 26 Edwards OM, Clark JD. Post-traumatic hypopituitarism. Six cases and a review of the literature. Medicine (Baltimore) 1986; 65 (05) 281-290
    CrossrefPubMedGoogle Scholar
  • 27 Markianos M, Seretis A, Kotsou A, Christopoulos M. CSF neurotransmitter metabolites in comatose head injury patients during changes in their clinical state. Acta Neurochir (Wien) 1996; 138 (01) 57-59
    CrossrefPubMedGoogle Scholar
  • 28 Popovic V. GH deficiency as the most common pituitary defect after TBI: clinical implications. Pituitary 2005; 8 (3-4): 239-243
    CrossrefPubMedGoogle Scholar
  • 29 Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the “euthyroid sick syndrome”. Endocr Rev 1982; 3 (02) 164-217
    CrossrefPubMedGoogle Scholar