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Cortisol evaluation during the acute phase of traumatic brain injury—A prospective study
Author(s) -
Bensalah Meriem,
Donaldson Malcolm,
Aribi Yamina,
Iabassen Malek,
Cherfi Lyes,
Nebbal Mustapha,
Medjaher Meriem,
Haffaf ElMehdi,
Abdennebi Benaissa,
Guenane Kamel,
Djermane Adel,
Kemali Zahra,
OuldKablia Samia
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13562
Subject(s) - medicine , glasgow coma scale , traumatic brain injury , context (archaeology) , hydrocortisone , basal (medicine) , adrenal insufficiency , cortisol awakening response , insulin tolerance test , coma (optics) , anesthesia , diabetes insipidus , endocrinology , insulin , insulin resistance , paleontology , physics , insulin sensitivity , psychiatry , optics , biology
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.