Traumatic Brain Injury and Pituitary Dysfunction: A Tertiary Care Hospital Based Study

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.

Weight homeostasis & its modulators in hyperthyroidism before & after treatment with carbimazole.

Background & objectives: Hyperthyroidism is associated with increased food intake, energy expenditure and altered body composition. This study was aimed to evaluate the role of adipocytokines in weight homeostasis in patients with hyperthyroidism. Methods: Patients (n=27, 11men) with hyperthyroidism (20 Graves’ disease, 7 toxic multinodular goiter) with mean age of 31.3±4.2 yr and 28 healthy age and body mass index (BMI) matched controls were studied. They underwent assessment of lean body mass (LBM) and total body fat (TBF) by dual energy X-ray absorptiometer (DXA) and blood sample was taken in the fasting state for measurement of leptin, adiponectin, ghrelin, insulin, glucose and lipids. Patients were re-evaluated after 3 months of treatment as by that time all of them achieved euthyroid state with carbimazole therapy. Results: The LBM was higher (P<0.001) in healthy controls as compared to hyperthyroid patients even after adjustment for body weight (BW), whereas total body fat was comparable between the two groups. Serum leptin levels were higher in patients with hyperthyroidism than controls (22.3±3.7 and 4.1±0.34 ng/ml, P<0.001), whereas adiponectin levels were comparable. Plasma acylated ghrelin was higher in patients than in controls (209.8±13.3 vs 106.2±8.2 pg/ml, P<0.05). Achievement of euthyroidism was associated with significant weight gain (P<0.001) and significant increase in lean body mass (P<0.001). The total body fat also increased but insignificantly from 18.4±1.8 to 19.9±1.8 kg. There was significant decrease (P<0.05) in serum leptin and acylated ghrelin but adiponectin levels remained unaltered after treatment. Serum leptin positively correlated with TBF and this correlation persisted even after adjustment for BW, BMI, gender and age (r=0.62, P=0.001). However, serum leptin and acylated ghrelin did not correlate with the presence or absence of hyperphagia. Interpretation & conclusion: Patients with hyperthyroidism predominantly had decreased lean body mass which increased after achievement of euthyroidism with carbimazole. The hyperphagia and the alterations in weight homeostasis associated with hyperthyroidism were independent of circulating leptin and ghrelin levels.

Prevalence of hypertension in patients with new onset type 2 diabetes mellitus.

This study was conducted to find out the prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus. Five hundred patients (229 men and 271 women) with type 2 diabetes mellitus diagnosed in the last 6 months were evaluated for hypertension and presence of various diabetes related complications. Overall 42% (210/500) of the patients had hypertension; more women (46.1%) than men (37.1%) were affected. Patients with hypertension were older, had higher body mass index and plasma triglyceride levels, and evidence of ventricular hypertrophy on electrocardiogram. Female sex, higher age, family history of hypertension or diabetes, history of neuropathic pains, higher body mass index, presence of albuminuria, dyslipidaemia or cardiac hypertrophy were found to affect prevalence of hypertension in newly diagnosed patients with type 2 diabetes mellitus.