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Cited by 28Adrenal Hormones and DisordersTraumatic Brain Injury and Neurovascular DisturbancesStress Responses and Cortisol

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

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Bensalah, Meriem, Donaldson, Malcolm, Aribi, Yamina, Iabassen, Malek, Cherfi, Lyes, Nebbal, Mustapha, Medjaher, Meriem, Haffaf, ElMehdi +5 more·2018·Clinical Endocrinology
DOI 10.1111/cen.13562
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Abstract

Summary: 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.

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  • Acute AI after TBI does not correlate with chronic AI in adults or children.

    “Notably, acute AI after TBI does not correlate with chronic AI in adults [3, 4, 9, 10] or children [11].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [9]

    The Discussion (p. 13) says acute-phase cortisol had poor predictive value for adrenal insufficiency on retesting three months later, supporting the point for adults, though not an absolute lack of correlation. The Methods (p. 5) restrict the study to patients aged 18–65, so this source does not support the claim about children. (LLM, conf=0.86)

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  • Chronic pituitary dysfunction is reported in up to 42% of children and adolescents after TBI.

    “and up to 42% of children and adolescents [6-9].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [9]

    The recovery-phase section (p. 11) reports post-traumatic hypopituitarism in 44% of patients three months after injury. The Results (p. 8) specify an age range of 18–65 years, so the paper does not support the attributed 42% figure for children and adolescents or establish a chronic prevalence in that group. (LLM, conf=0.88)

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  • Acute pituitary dysfunction does not correlate with chronic pituitary deficiencies.

    “Even acute pituitary dysfunction-abnormal findings in the first months after injury-has been shown not to correlate with chronic pituitary deficiencies [3, 4, 9-11].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [9]

    The Adrenal axis function results (p. 10) report no meaningful correlation between acute cortisol levels and adrenal testing three months after traumatic brain injury. That supports the claim for the adrenal axis, but the paper does not establish a lack of correlation for pituitary dysfunction generally or for deficiencies beyond the three-month follow-up. (LLM, conf=0.88)

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  • Central DI/AVP-D is associated with mortality after TBI.

    “a number of studies have reported that central DI/AVP-D is associated with mortality [3, 9, 12, 13].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [9]

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Research works printed but not linked: 5

  1. [2]2. Delemer B, Touraine P. Traumatic brain injury and pituitary insufficiency. Ann. Endocrinol. (Paris) .2006; 67: 310-315.
  2. [4]4. R, Guilavogui V, Metellus P. Profile of cranio-cerebral trauma and spinal cord trauma related road accidents in Guinea. Neurochirurgie . 2012; 58: 287-292.
  3. [11]11. Carmichael D J. in the Pituitary (ed. Melmed. S.) 343-373 (Masson Elsevier. 2011).
  4. [16]16. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet . 1975; 1: 480-4.
  5. [31]31. Dimopoulou I, Alevizopoulou P, Dafni U, Orfanos S, Livaditi O, Tzanela M, Kotanidou A, Souvatzoglou E, Kopterides P, Mavrou I, Thalassinos N, Roussos C, Armaganidis A, Tsagarakis S . Pituitary-adrenal responses to human corticotropin-releasing hormone in critically ill patients. Intensive Care Med . 2007; 33: 454-459.

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Authors
Bensalah, M., Donaldson, M., Aribi, Y., Iabassen, M., Cherfi, L., Nebbal, M., Medjaher, M., Haffaf, E., Abdennebi, B., Guenane, K., Djermane, A., Kemali, Z., & OuldKablia, S.
Affiliations
  • Endocrinology Unit Central Hospital of Army Algiers Algeria
  • University of Glasgow (GB)
  • Critical Care Unit Central Hospital of Army Algiers Algeria
  • Neurosurgery Unit Central Hospital of Army Algiers Algeria
  • Nuclear Medicine Unit Central Hospital of Army Algiers Algeria
  • Critical Care Unit Salim Zemirli Hospital Algiers Algeria
  • Neurosurgery Unit Salim Zemirli Hospital Algiers Algeria
  • Faculty of Medicine of Algiers Algiers Algeria
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2018-03-02
Volume
88
Issue
5
Pages
627-636
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.13562
OpenAlex
W2788388413
Cited by
28
References
34
Citations by year
2026: 1 · 2025: 5 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2
FWCI
2.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
traumatic brain injury, adrenal insufficiency, serum cortisol, acute phase, hydrocortisone replacement, hypotension, diabetes insipidus, skull base fracture, sedatives, mortality, insulin tolerance test, Glasgow Coma Scale
MeSH terms
Brain Injuries, Traumatic, Adolescent, Adult, Aged, Female, Humans, Hydrocortisone, Hypotension, Male, Middle Aged, Prospective Studies, Risk Factors, Young Adult

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