traumatic brain injury ( tbi ) is a nondegenerative , noncongenital insult to the brain from an external mechanical force causing temporary or permanent neurological dysfunction .
it is one of the major causes of morbidity and mortality in both the developed as well as the developing countries .
the prevalence of hypopituitarism after tbi is at least 25% among long - term survivors with significant impact on morbidities and mortalities . in india
the main aim of the study was to determine the prevalence of pituitary hormone deficiencies in the acute phase of tbi .
the secondary objectives were to correlate the severity of trauma with basal hormone levels and to determine whether initial hormone deficiencies predict mortality . in this cross - sectional , convenient sample study ,
49 consecutive patients with tbi ( 41 men , 8 women ; age range 1678 years ) who were admitted to the trauma care center of tertiary care center in mumbai were included .
the study was approved by our institutional ethical committee and conducted between 2013 and 2014 .
the level of consciousness of the patients was evaluated according to the glasgow coma scale ( gcs ) as soon as the patient was admitted to the trauma care center .
a score of 1315 was considered as mild , 912 moderate , and 8 as severe tbi .
patients who had suffered a prolonged hypotensive episode ( systolic pressure < 90 mmhg for more than 30 min ) , had a history of any known pituitary disorder or on any drug affecting hypothalamo - pituitary function , and pregnant women were excluded from the study .
all patients underwent basal hormonal evaluation within the first 24 h of the admission before receiving glucocorticoids and dopamine .
the samples of thyroid - stimulating hormone ( tsh ) , free triiodothyronine ( ft3 ) , free thyroxine ( ft4 ) , prolactin ( prl ) , cortisol , adrenocorticotropic hormone ( acth ) , follicle stimulating hormone ( fsh ) , luteinizing hormone ( lh ) , insulin - like growth factor-1 ( igf - i ) , growth hormone ( gh ) , and total testosterone were collected and estimated on chemiluminescence immunoassay ( advia centaur cp ) .
the hormonal deficiency was defined as described in table 1 and the analytic methods to measure hormones with inter- and intra - assay coefficient of variance has been described in table 2 .
criterion to define deficiency of various hormones analytic methods to measure hormones in this study statistical analysis was performed using the statistical package for the social sciences 17.0 ( chicago : spss inc ) program .
in addition , we used pearson 's correlation analysis to determine whether significant correlations existed between chosen variables .
a multifactorial logistic regression model was used to determine which variables independently predicted the development of mortality ; p < 0.05 was considered statistically significant .
the main aim of the study was to determine the prevalence of pituitary hormone deficiencies in the acute phase of tbi .
the secondary objectives were to correlate the severity of trauma with basal hormone levels and to determine whether initial hormone deficiencies predict mortality .
in this cross - sectional , convenient sample study , 49 consecutive patients with tbi ( 41 men , 8 women ; age range 1678 years ) who were admitted to the trauma care center of tertiary care center in mumbai were included .
the study was approved by our institutional ethical committee and conducted between 2013 and 2014 .
the level of consciousness of the patients was evaluated according to the glasgow coma scale ( gcs ) as soon as the patient was admitted to the trauma care center .
a score of 1315 was considered as mild , 912 moderate , and 8 as severe tbi .
patients who had suffered a prolonged hypotensive episode ( systolic pressure < 90 mmhg for more than 30 min ) , had a history of any known pituitary disorder or on any drug affecting hypothalamo - pituitary function , and pregnant women were excluded from the study .
all patients underwent basal hormonal evaluation within the first 24 h of the admission before receiving glucocorticoids and dopamine .
the samples of thyroid - stimulating hormone ( tsh ) , free triiodothyronine ( ft3 ) , free thyroxine ( ft4 ) , prolactin ( prl ) , cortisol , adrenocorticotropic hormone ( acth ) , follicle stimulating hormone ( fsh ) , luteinizing hormone ( lh ) , insulin - like growth factor-1 ( igf - i ) , growth hormone ( gh ) , and total testosterone were collected and estimated on chemiluminescence immunoassay ( advia centaur cp ) .
the hormonal deficiency was defined as described in table 1 and the analytic methods to measure hormones with inter- and intra - assay coefficient of variance has been described in table 2 . criterion to define deficiency of various hormones analytic methods to measure hormones in this study
statistical analysis was performed using the statistical package for the social sciences 17.0 ( chicago : spss inc ) program .
in addition , we used pearson 's correlation analysis to determine whether significant correlations existed between chosen variables .
a multifactorial logistic regression model was used to determine which variables independently predicted the development of mortality ; p < 0.05 was considered statistically significant .
the most common mode of injury was a road traffic accident ( 55% ) followed by a fall ( 34% ) , railway accident ( 6.1% ) , and assault ( 4.08% ) .
twenty - nine ( 59.18% ) patients had mild , 4 ( 8.16% ) had moderate , and 16 ( 32.65% ) had severe tbi .
comparison between mild , moderate , and severe tbi groups in acute phase is described in table 3 .
ten of 49 patients died during the acute phase , 7 of them had severe tbi .
comparison between mild , moderate , and severe traumatic brain injury groups in acute phase based on the criterion defined in table 1 , 63.5% patient had gonadotropin deficiency , 46.9% had low igf-1 level , 12.24% had cortisol level < 7 mcg / dl , 6.1% had low ft4 level , and prl level was high in 4% of patients .
cortisol levels were significantly higher in patients with low gcs ( r = 0.42 ; p = 0.0027 ) and cortisol levels were positively correlated with acth levels ( r = 0.43 , p = 0.002 ) suggestive of hypothalamo  pituitary  adrenal axis activation .
igf-1 did not correlated with severity of injury while gh is higher in patients with severe compared to mild tbi ( p = 0 .
the ft4 and ft3 positively correlated with gcs ( r = 0.31 ; p = 0.041 , r = 0.49 ; p = 0.0003 , respectively ) . in our male cohort
, there was a positive correlation between total testosterone and gcs in male , but the correlation was not significant ( r = 0 .
significant correlations glasgow coma scale and serum cortisol level ( a ) , serum adrenocorticotropic hormone and serum cortisol levels ( b ) , between glasgow coma scale and serum prolactin level ( c ) mean age , gcs , and basal hormone levels of the patients who died after tbi no survivors ( ns ) , 10 patients , were compared with the living patients survivors ( s ) , 39 patients [ table 4 ] . the ft3 level ( ns : 2.05  1.6 , s : 1.54  30.47 ; p = 0.0027 ) were significantly lower in nsg .
there was no significant difference in mean ft4 , tsh , prl cortisol , acth , fsh , lh , igf - i , gh , and total testosterone between the ns and s. logistic regression analysis revealed that mortality after tbi was unrelated to the basal pituitary hormone levels except low t3 level , which was found related to mortality . comparison between survivors and nonsurvivors of traumatic brain injury
tbi in acute phase can lead to pituitary dysfunction , results in a temporary increase or decrease in pituitary hormonal levels . in our study ,
gonadal axis was most common which was concordant with other studies . according to the previous studies , acute phase of tbi associated with low or high gh with low igf-1 .
we found low igf-1 in 46.9% of patients , but it was not correlating with severity which is also demonstrated by tanriverdi et al .
gh was high in patients with severe tbi compared to mild tbi ( p = 0.02 ) .
gonadotroph and somatotroph cells are located in the vascular territory of the long hypophyseal system which can be easily affected by tbi , which explains most common involvement of these axes . as described in various studies cortisol level
was found to increase immediately following tbi , and it was concordant with acth level suggestive of activation of hypothalamic  pituitary  adrenal axis .
low cortisol ( < 7 mcg / dl ) was found in 12.24% of patients , suggestive of posttraumatic damage at the hypothalamic - pituitary level .
prl level correlated positively with the severity of the tbi , which may represent stress response to tbi .
we found ft3 , ft4 were significantly lower in patient with increasing severity of tbi .
increased level of prl and low level of ft3 , ft4 , and cortisol correlated significantly with the severity of tbi . during acute phase of tbi at least assessment of cortisol
our future plan is to follow this cohort of patients for the assessment of long - term hormonal deficiency which could be factor for improvement in quality of life .
 introduction : traumatic brain injury ( tbi ) is an under - recognized cause of hypopituitarism . 
 according to recent data , it could be more frequent than previously known . however , there is a scarcity of data in indian population.aims:the main aim of the study was to determine the prevalence of pituitary hormone deficiencies in the acute phase of tbi . 
 the secondary objectives were to correlate the severity of trauma with basal hormone levels and to determine whether initial hormone deficiencies predict mortality.subjects and methods : forty - nine tbi patients ( 41 men and 8 women ) were included in this study . 
 pituitary functions were evaluated within 24 h of admission.results:gonadotropin deficiency was found in 65.3% patient while 46.9% had low insulin - like growth factor-1 , 12.24% had cortisol level < 7 mcg / dl . 
 cortisol and prolactin level were positively correlated with the severity of tbi suggestive of stress response . 
 free triiodothyronine ( ft3 ) and free thyroxine were significantly lower in patients with increasing severity of tuberculosis . 
 logistic regression analysis revealed that mortality after tbi was unrelated to the basal pituitary hormone levels except low t3 level , which was found to be positively related to mortality.conclusions:pituitary dysfunction is common after tbi and the most commonly affected axes are growth hormone and gonadotropin axis . 
 low ft3 correlates best with mortality . during the acute phase of tbi , 
 at least an assessment of cortisol is vital as undetected cortisol deficiency can be life - threatening 