Low total cortisol correlates closely with low free cortisol in traumatic brain injury and predicts mortality and long-term hypopituitarism

Hdl Handle:
http://hdl.handle.net/10147/239761
Title:
Low total cortisol correlates closely with low free cortisol in traumatic brain injury and predicts mortality and long-term hypopituitarism
Authors:
Hannon, M J; Crowley, R K; Behan, L A; O'Sullivan, E P; Rogers, B; Rawluk, D; O'Dwyer, R; Agha, A; Thompson, C J
Citation:
Endocrine Reviews (2011) 32:3 Meeting Abstracts. : June 2011
Journal:
Endocrine Reviews
Issue Date:
Jun-2011
URI:
http://hdl.handle.net/10147/239761
Additional Links:
http://edrv.endojournals.org/cgi/content/meeting_abstract/32/03_MeetingAbstracts/OR28-4
Abstract:
Published data has demonstrated that low 0900h plasma total cortisol (PTC) in the acute phase following traumatic brain injury (TBI) predicts mortality. However, there is concern regarding the use of PTC to evaluate the pituitary-adrenal axis in acutely unwell patients due to potential discrepancies between PTC and plasma free cortisol (PFC) due to variations in corticosteroid binding globulin (CBG). We hypothesised that low PTC would correlate closely with PFC and would predict mortality and long-term hypopituitarism.100 patients (84 men, median age 33, range 18-75) were recruited on admission with TBI (mean GCS+/-SD = 8.59+/-4.2). Each patient had PTC and CBG measured on days 1, 3, 5, 7, and 10 following TBI. Results were compared with 15 patients admitted to ITU following vascular surgery. A PTC <300nmol/L in a patient in ITU was regarded clinically as inappropriately low. PFC was calculated for 25% of TBI samples and all control samples using Coolen's equation (1). TBI patients reattended for dynamic pituitary testing >6 months after TBI.All controls had PTC >500 nmol/L on day 1, and >300 nmol on days 3–10. By contrast, 78/100 TBI patients had at least one PTC <300 nmol/L.TBI patients in the lowest quartile of final PTC measurement had the highest mortality (p=0.0187). PTC correlated closely with PFC in both TBI patients (r=0.99, p<0.0001) and controls (r=0.99, p<0.0001). 32/79 (40.5%) of TBI survivors attended for dynamic pituitary testing. The median time to dynamic pituitary testing was 14 months (range 6–24 months). 15/32 (46.9%) underwent insulin tolerance testing, 9/32 (28.1%) underwent glucagon testing and 8/32 (25%) underwent short synacthen testing. 6/32 (18.8%) were ACTH deficient, of whom 5/6 (83.3%) previously had low PTC. 6/32 were GH deficient, all of whom previously had low PTC. One patient was gonadotropin deficient; he previously had low PTC. No patients were TSH or prolactin deficient. Overall, 12/32 (37.5%) had one or more pituitary hormone deficits. Lower mean PTC and final PTC were strongly associated with the development of chronic hypopituitarism (p = 0.049 and 0.015 respectively). There were no significant differences between those patients with acute or chronic hypopituitarism and those with no deficits in terms of age, initial GCS or CT appearances.PTC is an accurate surrogate marker of PFC in acutely unwell patients. Low PTC following TBI is predictive of mortality, and long-term hypopituitarism in TBI survivors.
Item Type:
Conference Presentation
Language:
en

Full metadata record

DC FieldValue Language
dc.contributor.authorHannon, M Jen_GB
dc.contributor.authorCrowley, R Ken_GB
dc.contributor.authorBehan, L Aen_GB
dc.contributor.authorO'Sullivan, E Pen_GB
dc.contributor.authorRogers, Ben_GB
dc.contributor.authorRawluk, Den_GB
dc.contributor.authorO'Dwyer, Ren_GB
dc.contributor.authorAgha, Aen_GB
dc.contributor.authorThompson, C Jen_GB
dc.date.accessioned2012-08-23T15:21:42Z-
dc.date.available2012-08-23T15:21:42Z-
dc.date.issued2011-06-
dc.identifier.citationEndocrine Reviews (2011) 32:3 Meeting Abstracts. : June 2011en_GB
dc.identifier.urihttp://hdl.handle.net/10147/239761-
dc.description.abstractPublished data has demonstrated that low 0900h plasma total cortisol (PTC) in the acute phase following traumatic brain injury (TBI) predicts mortality. However, there is concern regarding the use of PTC to evaluate the pituitary-adrenal axis in acutely unwell patients due to potential discrepancies between PTC and plasma free cortisol (PFC) due to variations in corticosteroid binding globulin (CBG). We hypothesised that low PTC would correlate closely with PFC and would predict mortality and long-term hypopituitarism.100 patients (84 men, median age 33, range 18-75) were recruited on admission with TBI (mean GCS+/-SD = 8.59+/-4.2). Each patient had PTC and CBG measured on days 1, 3, 5, 7, and 10 following TBI. Results were compared with 15 patients admitted to ITU following vascular surgery. A PTC <300nmol/L in a patient in ITU was regarded clinically as inappropriately low. PFC was calculated for 25% of TBI samples and all control samples using Coolen's equation (1). TBI patients reattended for dynamic pituitary testing >6 months after TBI.All controls had PTC >500 nmol/L on day 1, and >300 nmol on days 3–10. By contrast, 78/100 TBI patients had at least one PTC <300 nmol/L.TBI patients in the lowest quartile of final PTC measurement had the highest mortality (p=0.0187). PTC correlated closely with PFC in both TBI patients (r=0.99, p<0.0001) and controls (r=0.99, p<0.0001). 32/79 (40.5%) of TBI survivors attended for dynamic pituitary testing. The median time to dynamic pituitary testing was 14 months (range 6–24 months). 15/32 (46.9%) underwent insulin tolerance testing, 9/32 (28.1%) underwent glucagon testing and 8/32 (25%) underwent short synacthen testing. 6/32 (18.8%) were ACTH deficient, of whom 5/6 (83.3%) previously had low PTC. 6/32 were GH deficient, all of whom previously had low PTC. One patient was gonadotropin deficient; he previously had low PTC. No patients were TSH or prolactin deficient. Overall, 12/32 (37.5%) had one or more pituitary hormone deficits. Lower mean PTC and final PTC were strongly associated with the development of chronic hypopituitarism (p = 0.049 and 0.015 respectively). There were no significant differences between those patients with acute or chronic hypopituitarism and those with no deficits in terms of age, initial GCS or CT appearances.PTC is an accurate surrogate marker of PFC in acutely unwell patients. Low PTC following TBI is predictive of mortality, and long-term hypopituitarism in TBI survivors.en_GB
dc.language.isoenen
dc.relation.urlhttp://edrv.endojournals.org/cgi/content/meeting_abstract/32/03_MeetingAbstracts/OR28-4en_GB
dc.titleLow total cortisol correlates closely with low free cortisol in traumatic brain injury and predicts mortality and long-term hypopituitarismen_GB
dc.typeConference Presentationen
dc.identifier.journalEndocrine Reviewsen_GB
dc.description.provinceLeinsteren
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