Acute Neuroendocrine Profile in Predicting Outcomes in Severe Traumatic Brain Injury: A Study from a Tertiary Care Center in South India

BACKGROUND: Pituitary dysfunction following severe traumatic brain injury (sTBI) is significant and may be correlated with the outcomes. AIMS AND OBJECTIVES: This study aimed to evaluate the early changes in pituitary hormone levels after sTBI and to correlate with outcomes in terms of severity and mortality. METHODS: This was a prospective, observational study, involving consecutive patients of 16–60 years, with sTBI (Glasgow Coma Scale GCS < 9) presenting to the hospital within 24 h of trauma. Demographic and clinical data were collected. Serum samples were collected in the morning (08–10 am) on day 1 and day 4 for cortisol, thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and prolactin (Chemiluminescence immunoassay). Outcome was assessed in terms of mortality (which included both immediate and at 3 months) and Glasgow outcome scale at 3 months. RESULTS: 54 patients were studied. Mean cortisol on day 4 was 28.5 μg/dL in alive patients and 13.7 μg/dL in patients deceased at 3 months (P < 0.001). Patients who were deceased at 3 months had significantly lower T3 on day 4 (0.973 vs 1.4 ng/dL) and lower T4 (8.1 μg/L vs 6.1 μg/dL) as compared to patients who survived (P = 0.049 and 0.005, respectively). Acute phase TSH on day 4 levels were significantly lower in patients deceased at 3 months. There was no significant difference in the prolactin levels. CONCLUSION: Day 4 cortisol, T3, T4, and TSH correlated with the outcomes at 3 months and hence have predictive value post-sTBI.