Format

Send to

Choose Destination
Clin Endocrinol (Oxf). 2018 May;88(5):627-636. doi: 10.1111/cen.13562. Epub 2018 Mar 2.

Cortisol evaluation during the acute phase of traumatic brain injury-A prospective study.

Author information

1
Endocrinology Unit, Central Hospital of Army, Algiers, Algeria.
2
Glasgow University School of Medicine, Glasgow, UK.
3
Critical Care Unit, Central Hospital of Army, Algiers, Algeria.
4
Neurosurgery Unit, Central Hospital of Army, Algiers, Algeria.
5
Nuclear Medicine Unit, Central Hospital of Army, Algiers, Algeria.
6
Critical Care Unit, Salim Zemirli Hospital, Algiers, Algeria.
7
Neurosurgery Unit, Salim Zemirli Hospital, Algiers, Algeria.
8
Faculty of Medicine of Algiers, Algiers, Algeria.

Abstract

BACKGROUND:

Biochemical diagnosis of adrenal insufficiency (AI) is difficult in the context of traumatic brain injury (TBI).

AIM:

To assess the frequency and predictive factors of AI in victims of TBI from Algiers.

METHODS:

Between November 2009 and December 2013, TBI victims had a single 8-9 am serum cortisol measurement during the acute postinjury period (0-7 days). AI was defined according to basal cortisol levels of 83, 276 and 414 nmol/L. Variables studied were TBI severity according to Glasgow coma scale, duration of intubation and coma, pupillary status, hypotension, anaemia, brain imaging findings, diabetes insipidus and medication. Insulin tolerance test was performed during the recovery phase, defining AI as peak cortisol <500 nmol/L.

RESULTS:

Cortisol samples were obtained at median 3 (1-7) days from 277 patients (257M: 20F) aged 32 (18-65) years. Acute AI frequency was 8 (2.8%), 20 (21%) and 35 (37%), respectively using the three cortisol cut-offs. Factors predicting AI were diastolic hypotension, sedative medication, diabetes insipidus, skull base fracture and intraparenchymal haematoma. Mortality was highest in patients with acute cortisol <276 nmol/L (44.6% with OR for death 1.64, 95% CI 0.92-3.0, P = .12). During the recovery phase, AI was present in 3 of 3, 12 of 24, 4 of 16 and 20 of 66 patients with week 1 cortisol <83, 83-276, 277-414 and >414 nmol/L.

CONCLUSION:

Hydrocortisone replacement is advised in TBI patients with morning cortisol <276 nmol/L or those <414 nmol/L with additional risk factors for AI. As acute and subsequent AI are poorly correlated, patients with moderate/severe TBI require adrenal re-evaluation during the recovery phase.

KEYWORDS:

adrenal insufficiency; cortisol; diabetes insipidus; diastolic hypopressure; sedative drugs; skull base fracture; traumatic brain injury

PMID:
29405355
DOI:
10.1111/cen.13562

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center