Evaluation of Acute Neuroendocrine Dysfunction Among Patients With Traumatic Brain Injury in Kenyatta National Hospital

Abstract

Background: Traumatic brain injury (TBI) is a weighty health issue globally, often resulting from falls and accidents, with severe cases impacting productive populations. Post-traumatic hypopituitarism (PTHP), historically underrecognized, is now acknowledged as a TBI complication. PTHP diagnosis is challenging due to symptom overlap with post-traumatic stress disorder. Pathophysiology involves pituitary gland vulnerability, potential portal system obstruction, infarction, and capsule damage. Hypopituitarism correlates with adverse outcomes, including cognitive impairment, reduced quality of life, metabolic issues, and hemodynamic instability. High-dose glucocorticoid use in acute TBI management has waned, with transient cortisol effects as part of the acute response. This study aimed to determine the prevalence of hypopituitarism among patients with traumatic brain injury in Kenyatta National Hospital. Methodology: This was a prospective cohort study conducted at the Kenyatta National hospital (KNH) neurosurgical wards and Intensive Care Unit. The study included those admitted to KNH with traumatic brain injury within 24 hours and a Glasgow coma scale <8. Informed consent was obtained from legal surrogates as most of the patients were incapacitated. Data viii collected using the data collection tool (Appendix III) for consented patients included age, post- resuscitative GCS score, pupillary status, ISS, sepsis presence, ICU and hospital stay lengths, and 3-month Glasgow Outcome Scale score. Follow-up occurred at 24 hours and 72 hours post admission until discharge or 1-month post admission for head injury-related complications. Data was analyzed with SPSS version 25. Descriptive statistics was used to outline characteristics of the study participants. Means and standard deviations were used for parametric data while medians and interquartile ranges were used for non-parametric tests, as determined by normality tests. P values of <0.05 at a confidence interval of 95% were considered statistically significant. Data was presented in representative tables, charts or graphs. Results: The study found a high prevalence of adrenal insufficiency (60.4%) and hypothyroidism (17.0%) among the participants. No significant gender differences were observed for either condition. Adrenal insufficiency was significantly associated with poorer 3-month Glasgow Outcome Scale scores (χ²(3) = 9.545, p = 0.023). Sepsis was significantly associated with hypothyroidism (χ²(1) = 4.633, p = 0.031). There were no significant associations between neuroendocrine dysfunction and age, pre-morbid conditions, or cause of injury. Conclusion: Neuroendocrine dysfunction, particularly adrenal insufficiency and hypothyroidism, is prevalent among TBI patients and impacts recovery outcomes. Routine endocrine assessments and multidisciplinary care are crucial for improving TBI management. Future research should focus on larger, longitudinal studies to further understand and address neuroendocrine dysfunction in TBI patients