Neuroendocrine Dysfunction in Acute Phase of Moderate to Severe Traumatic Brain Injury - A Single Centre Prospective Observational Study

Abstract

Traumatic brain injury (TBI) is a common neurosurgical condition frequently associated with acute neuroendocrine dysfunction. This single-centre prospective observational study was conducted in the Department of Neurosurgery, Government Medical College Kozhikode, from 2021–2022 to determine the relationship between neuroendocrine dysfunction, severity of trauma, CT pressure effects, and Glasgow Outcome Scale (GOS) in patients with moderate to severe head injury. A total of 126 patients underwent hormonal evaluation (FT3, FT4, TSH, GH, cortisol, and prolactin) within 24 hours of admission and on day 7, and results were correlated with Glasgow Coma Scale (GCS), GOS, and radiological findings. On day 1, patients with severe injury had significantly higher GH, cortisol, and prolactin levels and lower FT4 and TSH levels compared to those with moderate injury, while FT3 remained unchanged. FT4 levels were significantly higher in moderate injury, whereas severe injury was associated with low or normal FT4 levels, with statistically significant associations observed on both day 1 and day 7. Cortisol levels were elevated in severe injury on day 1, with an increased number of patients showing high cortisol levels on day 7. Most hormonal comparisons demonstrated statistically significant associations (p < 0.001), except growth hormone (p = 0.726). These findings indicate that acute neuroendocrine alterations correlate with injury severity and clinical outcomes in moderate to severe traumatic brain injury. Materials and Methods: This study was a single centre prospective observational study done at Department of Neurosurgery Government Medical College Kozhikode in all cases of Moderate to Severe Head injury from 2021-2022. The hormone levels were correlated with Glasgow coma scale (GCS), GOS, extent of injury and pressure effects on CT. The details were recorded and analysed with SPSS software. Results: On day 1 Patients who had severe injury had significantly more GH(6.60± 2.63 vs 1.65±2.23), cortisol (34.19± 4.86 vs 15.51 ± 3.93) and prolactin (5.88 ± 3.43 vs 14.07 ± 6.27) than moderate head injury patients. Also patients with severe injury had significantly less FT4 (1.49± 0.26 vs 1.21±0.24), TSH (1.67± 1.50 vs 0.69 ±0.45) than moderate head injury patients. FT3 was same for both moderate and severe injury patients. FT4 was significantly high in patients with moderate injury while in cases with severe injury more number of patients had low or normal FT4. This association was statistically significant on day 1 and day 7. Cortisol levels on day 1 showed that patients with severe injury had high cortisol levels in day one while on day 7 the number of patients with high cortisol increases. Conclusion: Patients with severe head injury had high GH, Cortisol, Prolactin and low FT4, TSH on Day 1 than moderate head injury. FT3 remained unchanged. Number of Patients with severe head injury with high Cortisol levels on Day 1 increased on Day 7. Multiple statistically significant associations were observed in the study, with most hormonal comparisons showing p < 0.001, except growth hormone (p = 0.726).