ABSTRACT
Traumatic brain injury (TBI), often is associated with lasting functional disability and represents a significant public health problem worldwide.It is one of the leading causes of death in young people in industrialized countries, and patients who survive suffer important clinical consequences, such as long-term cognitive, behavioral, and social defects. Aims and objectives: 1) To determine the frequency of acute corticotrophin deficiency in head injury patients with one week of TBI. 2) To determine the incidence of permanent hypopituitarism, 6 months after TBI in Kashmiri population - a potentially high-risk group: SS prone population.3) To study the factors affecting the development of hypopituitarism after TBI in Kashmiri population. Methods: This observational study was jointly carried out by the Departments of Endocrinology and Neurosurgery at the Sher-i-Kashmir Institute of Medical Sciences Srinagar (SKIMS) in collaboration with the Department of Immunology & Molecular Medicine of our institution. After obtaining formal consent, history and examination and baseline investigations, a hormonal profile for evaluation of pituitary dysfunction was taken within one week of presentation and later after 6 months of trauma including stimulation with glucagon injection. Results: RTA and fall from height were two common causes of head injury. GCS of the study subjects ranged from 3 to 15 with a median of 11, with 19 subjects (23.5%) having GCS of 8 or less. GCS varied from mild 6.5% to moderate 10.3% and severe 18.3% in terms of APACHE scores. Sick euthyroid syndrome and hypogonadism was seen in 83% and 60.5 % of patients in acute phase which after 6 months period settled at 5.65 and 17.6 % respectively. 52.6 and 18.4 % had one and two axis involvement at time of presentation and 14.3% and 59.5% had one and two axis involvement at 6 months interval of trauma. Conclusion: we conclude that hypopituitarism is a clinical condition much more common than previously thought. Considering the epidemiology of TBI and percentage of related hypopituitarism, we are facing a disease that is far more common than perceived one.