Traumatic brain injury (TBI) remains a complicated and urgent disease in our modernized cities. It becomes now a public health disease. We have got more and more patients in Neurosurgery Intensive Care Unit following motor vehicle accidents and others causes. TBI brings multiple disorders, from the primary injury to secondary injury. The body received the disturbances in the brain, in the hypothalamo-pituitary-adrenocortical (HPA) axis, in the gastric mucosa, in the immune and neuroendocrine systems. The mortality of TBI is more than 50 000 deaths / year, the third of the mortality of all injuries. Cushing ulcer is one of the severe complications of TBI and its mortality rate is more than 50%. Many studies have improved the management of TBI and the associated complications to give patients a better outcome. Furthers studies need to be done based on the similar methodology to clarify the different steps of the HPA axis and the neuroendocrine change associated. The aim of the present review is to assess the clinical and endocrinal features of hypopituitarism and stress ulcer following TBI.
Brain Injuries ; complications ; physiopathology ; Humans ; Hypopituitarism ; etiology ; Hypothalamo-Hypophyseal System ; physiopathology ; Pituitary-Adrenal System ; physiopathology ; Stomach Ulcer ; etiology

OBJECTIVETo evaluate the local risk factors of traumatic brain injury (TBI) patients developing gastrointestinal (GI) bleeding during the early hospitalization in neurosurgery intensive care unit (NICU).

METHODFrom September 2005 to February 2006, 41 patients admitted to NICU and 13 healthy volunteers were involved in our study. Blood samples at 24 hours, 2-3 days and 5-7 days were obtained from each patient via arterial line at 8 a.m. to measure the concentrations of serum adrenocorticotropic hormone (ACTH), total cortisol and gastrin. The collected serum was immersed in an ice bath and tested by the Immulite 1000 systems. Data were analyzed by SPSS 11.5.

RESULTSWithin 24 hours following TBI, the concentrations of total cortisol, ACTH and gastrin increased proportionally to the severity of injury, especially significant in the experimental group (P less than 0.05). The concentrations of ACTH and gastrin were higher in the GI bleeding positive group than in the GI bleeding negative group, (F equal to 1.413, P less than 0.253) for ACTH and (F equal to 9.371, P equal to 0.006) for gastrin. GI bleeding had a positive correlation with gastrin concentration (r equal to 0. 312, P less than 0.05) and a negative correlation with serum hemoglobin (Hb) (r equal to -0.420, P less than 0.01). The clinical incidence of GI bleeding was 24.39% (10/41) in the experimental group. Within 24 hours, GI bleeding had a strong correlation with gastrin concentration (OR equal to 26.643, P less than 0.05) and hematocrit (Hct) (OR equal to 5.385, P less than 0.05). High ACTH concentration ( larger than 100 pg/ml) increased the frequency of GI bleeding. For patients with severe TBI and treated with routine antacids, the incidence of GI bleeding was 40.91% (9/22) and the mortality rate was 20% (2/10).

CONCLUSIONSLow Glasgow coma scale scores, low Hb, high concentrations of gastrin and ACTH (larger than 100 pg/ml) are risk factors and can be predictive values for post-traumatic GI bleeding. Severe TBI patients have high risks of GI bleeding with high mortality.

Adolescent ; Adrenocorticotropic Hormone ; blood ; Adult ; Aged ; Brain Injuries ; blood ; complications ; mortality ; Female ; Gastrins ; blood ; Gastrointestinal Hemorrhage ; blood ; etiology ; mortality ; Glasgow Coma Scale ; Humans ; Logistic Models ; Male ; Middle Aged ; Risk Factors