PREVALENCE OF PITUITARY DYSFUNCTION IN MODERATE-TO-SEVERE TRAUMATIC BRAIN INJURY IN ADULTS: A PROSPECTIVE STUDY.

Abstract

Background: Traumatic brain injury (TBI) is a growing public health problem worldwide and is a leading cause of death and disability. Hormonal alterations leading to post-traumatic pituitary dysfunction (PTPD) usually become apparent in the rst hours or days after TBI.In this study, we focused on the prevalence of anterior and posterior pituitary hormonal alterations in the acute and chronic post-TBI period in adults. Material & Method: The study design is a prospective study done in RIMS, Ranchi from March 2021-March 2023. Patients of TBI who were fullling our inclusion criteria were randomly selected. All pituitary hormonal assessmentwas done both in the acute phase (within 14 days of post-TBI) and chronic phase (1 month, 3 months & 6 months post-TBI). The outcome of patients was analyzed by Modied Rankin Scale. Result: Mean ± SD (range) age at the time of TBI in the 80 patients (62 Male:18 Female) was 40.24 ± 16.77 (18-65) years with moderate TBI (GCS 9-12) in 59 (73.75%) and severe TBI (GCS < 8) in 29 (36.25%). RTA was the most frequent cause, occurring in 83.75% of patientsDuring acute phase 16 patients (25%) are found having AI with serum cortisol level 179 ± 98.25nmol/L (< -2 SD). 10 out of 80 patients were found to have GHD (IGF-1 <-2SD) at the end of 3 months & 6 months post-TBI.Presence of DI was seen in 10/80 (12.5% of patients) which is identied around 13 ± 4.52 days. Hypothyroidism was seen in 5% and hypogonadism in 2.5% of study population. Conclusion: Despite the publication of several case series, the true incidence of PTHPremains a matter of considerable debate with divergent rates reported between centers. Acoordinated approach by neurosurgeons, endocrinologists, and the neurorehabilitation unit is fully recommended to provide adequate care to these patients.