Abstract
Background :Traumatic brain injury (TBI) has become a major public health concern in developing and developed countries as it affects productivity and economy. The incidence, prevalence, and scope of survival and recovery from acute and chronic post-traumatic pituitary dysfunction (PTPD) have not been comprehensively assessed. Post-traumatic hypopituitarism accounts for 7.2% of all hypopituitarism cases. The identification of patients with acute brain injury who are at risk of hormonal deficiency and the provision of appropriate interventions can reduce morbidity associated with TBI.
Study objectives:
• Assess the proportion of patients with severe head injury (Glasgow coma scale [GCS] score of < 9) who are at risk of reduced thyroidstimulating hormone (TSH), free T3 (FT3), free T4 (FT4), and serum cortisol levels within the first week after trauma.
• Develop the Acute TBI Hormone Assessment Score (ATBIHAS), which is a 12-point scoring system comprising clinical and radiological parameters, and evaluate its correlation with hormone reduction during the acute phase of trauma, specifically on the fourth day.
• Investigate whether the ATBIHAS can be used to quantify the percentage of hormonal reduction on the fourth day after trauma.
• Evaluate the correlation between GCS score and hormonal reduction on the fourth day after trauma.
Methods :
This prospective observational study was conducted at the Neurosurgical Department of Rajiv Gandhi Government General Hospital, Chennai, India. In total, 30 patients with severe head injury who underwent brain computed tomography (CT) scan after the initial resuscitation and within the first 24 h after presentation were included in the analysis. Clinical Georg Thieme Verlag KG, P.O. Box 30 11 20, 70451 Stuttgart, Germany Manuscript submitted to Editorial Office of Central European Neurosurgery For Peer Review data were collected, and brain CT scan findings were recorded in the proforma. Moreover, information about sphenoidal hemosinus, frontal contusion, temporal contusion, edema, infarct, midline shift, and bony calvarial fracture was recorded. The ATBIHAS, a 12-point scoring system comprising clinical and radiological features and surgical procedures for the current scenario, was developed. This tool can assess pituitary stalk injury and hypothalamic pituitary axis disruption. All participants underwent the thyroid profile test, which comprised TSH, FT3, FT4, and serum cortisol levels. Samples were collected between 7:00 and 9:00 am on the day after the patient was successfully resuscitated. This time period was selected to prevent diurnal variations in hormone levels. The test was repeated between 7:00 and 9:00 am on the fourth day of admission. Data about all hormonal levels and their variations on the fourth day were assessed and compared with the ATBIHAS. This study was approved by the institutional ethics committee.
Results:
Among the participants, 27 were men and 3 women. Approximately 33.3% and 6.7% were aged 20–29 and 50–59 years, respectively. Hormonal reduction between the first and fourth days after trauma significantly differed (P < 0.001). The incidence rates of hormonal reduction after the fourth day of trauma were 90% for TSH, FT4, and serum cortisol and 93% for free T3. The ATBIHAS was found to be positively correlated with reduced TSH, FT3 and FT4, and serum cortisol levels. A higher score indicated a greater percentage of hormone reduction on the fourth day after trauma. However, there was no significant correlation between the GCS score as well as the ATBIHAS and TSH, FT3, FT4, and serum cortisol reduction (P > 0.05).
Conclusion:
Approximately > 90% of patients with severe head injury are at risk for TSH, FT3, FT4, and serum cortisol reduction within the first week after trauma. Moreover, there is a significant linear correlation between ATBIHAS and hormonal levels during the acute phase of trauma, specifically on the fourth day.

Key words: Acute Traumatic Brain injury, Hormonal assessment score, hormonal reductions