Endocrine Abstracts

Background: Biological diagnosis of adrenal insufficiency (AI) is very difficult in the setting of critical illness like in traumatic brain injury (TBI), and the cut off defining AI need more precision.

Aim: The aim is to assess the frequency and predictive factors of AI in a simple of 277 victims of moderate to severe BI in two neighbors’ hospitals in the east of Algiers.

Method: Between November 2009 and December 2013, 277 patients victims of moderate to severe TBI aged from 18–65 years old were included.During the acute post injury period (0–7 days), the measurement of serum cortisol has been done in all patients at 8–9 pm. TBI subjects were defined as having AD using three cut offs: 83 nmol/ (the value that indicate severe AI usually admitted by endocrinologists), 276 nmol/l (the value indicating AI in critical illness according to the consensus statements from an international task force by the American college of critical care medicine), 414 nmol/(the value admitted by Hannon and al which indicate AI in victims of TBI). Variables studied were: age, severity of BI, duration of intubation and coma, pupillary status,presence of hypotension and anemia (Hb<9 dg/ml). CT findings were classified according to Marshall Classification, the presence of skull base fracture was assessed. The presence of insipidus diabetes, the kind of medications used for sedation has been assessed in intubated patients. The outcome was evaluated by the GOCS.

Result: Mean age was 32 years with male predominance. Traffic accident was the most frequent cause of brain injury The frequency of acute AD was 2.8% 20.21% and 35.37% respectively for cortisol levels of 83 nmol/l.276 nmol/l and 415 nmol/l respectively. Predictive factors for its occurrence was the acute diastolic blood pressure, prescription of Pentobarbital, acute insipidus diabetes, skull base fracture and the presence of intraparenchymal hematoma but at different levels of cortisol.